Welcome to Medical & Safety!


#1

The purpose of this topic on the Wildland Intel Forum is the keep the forward progression of Wildland Fire Medicine. There area lot of ailments, injuries and basic healthcare needs that happen on wildfires. This can be anything from a reoccurring tooth ache, back pain, chainsaw to the leg, vehicle accident, medication refill, mental health issues, etc. It is our main job to provide for the heath, wellness and safety of the wild land fire crews and supporting personnel on the fires. This topic can also be used to discuss questions about REM Teams gear, techniques, links, trainings, etc.

Whether we are a private, city, state or USFS employee, it is our job to provide the best possible care we can to the level of training we have.

So, how can you be involved in this thread?

~ Ask Questions? (#6 on your 18 Watchout Situations)
#6: “Instructions and Assignments are not Clear”
Fireline EMTs or Medics tend to go out on assignment as a “Single Resource”. And it may be your first assignment as an EMT/Medic. I’ve seen a lot of “green” people headed out to the Fireline not really knowing whom they need to check in with, map reading issues, radio issues, lack of medical gear, etc.

So, if you are new or want to become a Fireline EMT or Medic, make sure you ask questions because you may be needed at a critical time and you are expected to know what to do.

~ Answer Questions!
I’m sure many MEDL or Safety Officers may be checking in on this thread. Or others that may have something to contribute, “The More Experienced Ones”. If you can and have time. Please answer questions and participate in the discussions. For the MEDLs, some of these questions may come from future line EMTs working for you.

Topics to Discuss

  • Poison Oak Treatments (Tecnu, Zanfel, Dawn Dish Soap, etc)
  • Snake Bite, Scorpion Sting, Brown Recluse treatments
  • REM Team Organization of gear
  • “Must Haves” for your webgear
  • Preferred AEDs
  • Etc, you get the idea…

Category Rules
Rule #1: HIPAA

Thanks and Enjoy!


#3

:rescue_worker_helmet: Looking forwarded to see more under this topic! @Mtnmedics1


#4

Chad my condolences. On a lighter note Let the questions fly. Let’s be safe out there.


#5

Looking forward to renewing these discussions - will be monitoring closely.


#6

Anybody carrying a suction device other than a V-Vac that fits better in their webgear?


#7

https://www.narescue.com/pre-hospital-care-ems-products/airway/nar-tactical-suction-device


#8


#9

images


#10

Make sure it gets properly disposed. Wouldn’t want any sea turtles eating any lung butter


#12

Thank you guys.


#13

Hey there Chad. Hoping this group can remain professional.
I was wondering what your thoughts are in regards to the use, administration of “DripDrop” or “Salt Stick Fast chews”.
We know that no matter how we educate our resources, that they will continue to consume high doses of caffeine, or not hydrate properly, or have nutritional challenges, or physical limitations. So, with that, what are your thoughts?


#14

Oh, new to the group and to the web site so still trying to figure out how to use it


#15

#16

#17

I have personally used drip drop on a few occasions. Pouring 1 packet in a liter of water after heavy exertion in hot 100^f days. I still hydrate throughout the day and the night before work. I do not use it as reason not to hydrate and eat properly for high heat work environments. I personally think it’s a good alternative to IV therapy and should be indicated where there is no vomiting for those experiencing heat stress.


#18

Does anyone if the CDC or FDA have any recommendations? Does the USFS have a policy? CalFire?


#19

OK here it goes… …My team here at Mountain Medics has been researching and discussing this topic over the past few days. So here is what we’ve come up with.

What are Oral Rehydrating Solutions/Salts?
Oral Rehydrations Solutions (ORS) are formulated powders, effervescent tablets or drinks that have a precise combination of salts, sugars and potassium. This combination allows for the most efficient way for the body to absorb water via the gastrointestinal system.

Oral Rehydrating Solutions vs I.V. Solutions
Oral Rehydrating Solutions are the preferred method of rehydration and electrolyte replacement. This is of course because it is way less invasive and if the patient is not actively vomiting the rate at which absorption into the cells is relatively the same. But, if the patient is vomiting, IV therapy will then be the route needed.

Oral Rehydrating Solutions vs. Sport Drinks vs. Water
Funny you ask… …this one comes in at an even tie between Oral Rehydrating Solutions and Water. They go together like Sonny & Cher, Chip & Dale, Peas and Carrots, Ceviche and Fire Camp, oh wait, scratch the last one. Point is, you have to have both components for each one to do their job. The Oral Rehydrating Solutions assists the movement of water across membranes and facilitates water going into the blood; then it moves into the cells through absorption in both the small and large intestines.

Sports Drinks however, have such a high concentration of sugars without the sodium. The body actually acts in an opposite manner because of this (ie: diffusion) and water can be pulled from the body and back into the intestines to try and equalize the concentration. (Just think back to 7th Grade Science Class.)

Are Oral Rehydrating Solutions Safe?
Really??? Are they safe??? When thinking about the wildland firefighting industry, Oral Rehydrating Solutions are about as safe as you can get next to getting your radio cloned. Even getting your radio cloned has it’s precautions. Over the years Oral Rehydrating Solutions have been used in 3rd world countries during cholera out breaks. Now days sport teams from high school to professional are using Oral Rehydrating Solutions. As far back as 1965 there was a beverage that consisted of a mixture of water, sodium, sugar, potassium, phosphate and lemon juice (guess which one?). And now this particular beverage is basically soda.

Well, last I checked, firefighters are some of the most bada** athletes I’ve ever known. What they put their bodies through to get a job done, is something that most couldn’t imagine. The excessive heat, poison oak, lack of sleep, PEP (pig, eggs and potatoes) brown bag lunches, different shades of gravies for dinner, etc. Don’t get me wrong, I’m very appreciative for the effort, but sometimes the “healthy” choices are lacking.

Long story short… YES, they are safe. Geez we trust you with chainsaws and pulaskies and just like your Pulaski, know how to use them.

Stay Tuned: Mountain Medics Lyndsey EMT is going to post her research paper on Oral Rehydrating Solutions.

Thanks again and Stay Safe!


#20

Oral Rehydration Solutions

As the temperatures continue to rise and the days get longer the medical staff at Mountain Medics have been seeing more and more cases of dehydration which has prompted us to explore the differences in various methods used for rehydration; and the differences between them.

Dehydration can present itself in several different ways; knowing the signs and symptoms and having a plan to prevent and treat them are essential. Restlessness and irritability, sunken eyes, dry mouth and tongue, increased thirst, decreased urine, lethargy or unconsciousness, very dry mouth and tongue, skin goes back very slowly when pinched (“tenting”), weak or absent pulse, low blood pressure, minimal or no urine can all be signs of dehydration.

Oral Rehydration Salts (ORS) is the non-proprietary name for a balanced glucose-electrolyte mixture, first used in 1969 and approved, recommended, and distributed by The United Nations Children’s Fund (UNICEF) and The World Health Organization (WHO) as a drug for the treatment of clinical dehydration throughout the world. In 1984, another mixture containing trisodium citrate instead of sodium hydrogen carbonate (sodium bicarbonate) was developed with the aim of improving the stability of ORS in hot and humid climates. For more than 20 years, WHO and UNICEF have recommended this single formulation of ORS to prevent or treat dehydration. (World Health Organization, 1998)

An ORS must have sufficient sodium to replace losses on a volume to volume basis, a glucose concentration that matches that of sodium to ensure its delivery to the ileum, sufficient amounts of potassium and base (e.g., sodium bicarbonate or trisodium citrate dihydrate) to correct acidosis and to enhance sodium absorption, and sufficient amounts of liquid (Sachdev, 1996).

DripDrop is an example of such; Drip Drop Hydration is an oral rehydration solution (ORS) rather than a sports drink. Each stick contains a precise and meticulously formulated ratio of electrolytes, glucose, and other important ingredients. The World Health Organization (WHO) recognizes ORS as essential for dehydration treatment and prevention and has been using the solution in the developing world for over 50 years. Studies have shown ORS to rehydrate as effectively as an IV.

One 21 gram stick of DripDrop mixed with 16 ounces of water delivers three times the electrolytes of sports drinks, with half the sugar. This optimal ratio of sodium to glucose allows for maximum absorption of electrolytes and fluid into the bloodstream. It is important to note that all packets used must conform to a national standard dose. This will avoid confusion in the field and reduce the risk of over- or under-concentration resulting from varying packet and container sizes. (Oral Rehydration Solution, 2018)

IV rehydration therapy is also often used during extreme dehydration situations. It had been long been thought that the immediate entry of fluids into the bloodstream would offer a multitude of benefits for an otherwise healthy, dehydrated athlete looking to replace fluids rapidly. However recent evidence indicates that when equal volumes of the same concentration of fluid are used for rehydration intravenously or orally, no performance or physiological advantage exists to justify the use of IV rehydration. IV treatment is invasive, requires trained medical staff, must be given off the field, and increases the risk of infection and bruising. Thus, an oral rehydration protocol is usually a more efficacious and safe hydration approach. Nevertheless, the fact remains that greater volumes can be tolerated from a gastrointestinal perspective than when the fluid is administered intravenously. (Van Rosendal, 2010)

Other oral rehydration products can be beneficial when it comes to fighting dehydration in the field; sports drinks provide needed calories and replenish lost electrolytes that are essential for proper body functions, fruit drinks and powdered electrolyte additives or tablets such as the NUUN tablets, can also provide one with the essential electrolytes needed to replenish what has been lost during the day.

It is important to remember that as much as treating dehydration is important to remain healthy and perform at one’s optimal capacity; the key is prophylactically staying hydrated, ensuring that you are continually drinking fluids and replenishing the minerals and electrolytes that are lost will prevent severe dehydration and possible further injury.

In conclusion; after comparing the various research done on the pros and cons of countless types of rehydration methods it is noted that each has their own strengths and weaknesses. Whichever method you decide to use will be beneficial. The additives that are found in these supplements are essential to adequately hydrate the body during strenuous activities and far exceed the benefits of water alone. It is important to keep in mind though as with anything, consumption of these products in excess is not suggested and it is important to read the packages and take them as recommended.

References
Oral Rehydration Solution. (n.d.). Retrieved July 13, 2018, from
https://dripdrop.com/pages /faq

Sachdev, H. P. (1996, August). Oral Rehydration Therapy. Retrieved July 12, 2018, from
https://www.ncbi.nlm.nih.gov/ pubmed/8855579

Van Rosendal, Simon & Andrew Osborne, Mark & Fassett, Robert & Lancashire, Bill &
Scott Coombes, Jeff. (2010). Intravenous versus Oral Rehydration in Athletes. Sports medicine (Auckland, N.Z.). 40. 327-46.

W. (1985). Oral Rehydration Salts. Production of the ORS, 1-123. Retrieved July 13,
2018, from http:// apps.who.int/iris/ bitstream/handle/10665/69227/WHO_FCH_CAH_06.1.pdf?sequence=1


#21

Great information. Thanks for adding this info. When all else fails read the label before taking.


#22

Great summary, Lyndsey. The only thing I have to add is that the mechanism by which ORS helps absorb fluids is via a sodium/glucose cotransporter proteins in our small intestines. Check out the Wikipedia article:

In short, we have a built-in mechanism for oral rehydration. Use it!