Greetings,

Here’s to wishing you a Happy July 4^th weekend!  While celebrations are often marked with cook outs, fireworks or even a day at the beach, those of us who work Emergency Medical Services are preparing to see an increase in call volume. 

To help everyone stay safe, I am writing to address common illness and injuries seen around this time.  

Here are some first aid measures that you can take to help someone: 

Diabetic Emergencies

Diabetics who are dependent on insulin are especially prone to emergencies in the summertime.  Alcohol and dehydration exacerbate blood sugar changes.  If a known diabetic person begins to show signs of lethargy, fruity-smelling breath or altered mental status, suspect blood sugar imbalance.  It is very easy to mistake an alcohol overdose with a diabetic emergency.  Also, keep in mind that folks affected by high blood sugar often get worse over a generally longer period of time while hypoglycemia (low blood sugar) usually has a very quick onset (less than 15 minutes).

Here’s what to do:

1. Testing the person’s blood sugar, while helpful to emergency medical personnel, will not change the way you treat the emergency.
2. Try to get the person to sit still. For safety, it is best to help them to the ground or a couch they will not fall out of and hurt themselves. 
3. The victim needs something with sugar in it. Chocolate, candy, non-diet soda, orange juice and apple juice are all good sources of quickly absorbed simple sugars. 
4. If their condition does not improve markedly in a few minutes, or if they are insulin dependent, call 911.

Overdose

It is probably worth mentioning some recent changes to the Good Samaritan Laws in New York State.  In an effort to get people the help they need during an overdose, police will not charge a victim or persons nearby in the presence of drugs for individual use, when called for a medical emergency.  If you think a friend or family member has overdosed, do not be afraid to call 911.  It will be most helpful if you can determine what substance(s) the victim overdosed on, as this may determine the course of treatment paramedics will take.

Signs of opiate overdose includes slow, shallow, or absent respirations, pin-point pupils and unresponsiveness to painful stimuli.   

To help a victim of an overdose:

1. Call 911 immediately.
2. Rub the victims’ sternum vigorously to see if they respond to pain.
3. If the victim is not responsive to pain, not breathing, or has slow or shallow respirations, begin hands-only CPR.
4. If you or someone nearby have attended a naloxone in-service class, suspect an opiate overdose, and have a “Narcan Kit”, administer 1 mg of Narcan in each nostril while continuing CPR.
5. If the victim awakens or begins to breathe at an adequate rate, stop chest compressions and place him/her on his/her side, mouth open and facing downward.
6. Be prepared to give a second dose if there is no improvement or if signs worsen again.

Many illnesses can be prevented by ensuring everyone is drinking plenty of water.  Diabetics should avoid alcoholic beverages and may need to check their blood sugar levels more frequently to make sure they are compensating for an abnormal diet.  Unfortunately, we may not be able to prevent overdoses, as much as we’d like to try.  In these cases, calling 911 and positioning the victim properly may be the only thing we can do.

Burns

Thermal burns from bar-b-ques and fireworks seem to be fairly common.  Burns can be classified as surficial, partial thickness or full thickness.  Surficial burns and partial thickness burns that cover less than 1% of the body (less than the size of the victim’s palm) may be considered minor.  These burns will often heal themselves.  For victims of partial thickness and large surface area burns, we worry about infection, heat loss and fluid loss. 

Follow these steps to care for burns that are smaller than 10% body area:

1. Run the burned area under cool water for at least 10 minutes or until pain free.
2. Remove any charred clothing not stuck to the skin.
3. Cover the burn with a non-stick, sterile bandage, and wrap loosely with clean roller gauze.
4. Never break blisters.
5. Use running water to cool burns to the face, do not use a bowl or bucket.
6. Call 911 or seek medical attention immediately if the burn is greater than 1% in area, affects at least most of the thickness of the skin, or involves the hands, feet, face, genitals or full circumference of a limb.

Amputation

Fireworks and other accidents can cause the loss of a finger, partial or full limb.  In all cases, your first priority is to call 911 and stop the bleeding by using direct pressure and clean gauze.  For larger amputations, arterial bleeding and victims who are on blood thinners, tie a tourniquet approximately   2 inches above the amputation and tighten until the bleeding stops. 

In many cases, limbs can be reattached.  Follow these steps to save the limb:

1. Rinse the amputated part under clean water for several seconds.
2. Wrap the part in clean gauze and place into a sealed plastic bag.
3. Place this bag inside of another sealed plastic bag that contains ice and a small amount of water. Take care to make sure the severed body part does not touch the ice directly.
4. Write the victim’s name, date and time on the bag, and give it to EMS for transport.

Of course, the best way to treat these injuries is to prevent them from happening in the first place.  Make sure your grill master is well hydrated while cooking.  Alcohol intake should be avoided until after the fire is out and every alcoholic beverage should be followed by plenty of water. 

Unless you are trained and qualified to set off fireworks, stay away from them.   If you are lighting fireworks, limit your alcohol intake and never relight a shortened fuse. 

Wishing you a happy and safe July 4^th,

Erik