Toxic-Environmental Protocol Section 1222 - 222 - If If Needed 800 if if indicated if indicated Immobilize Immobilize injury - Protocol TB6 Protocol TB4 Protocol 1 Multiple Multiple Trauma LargeOrganism Extremity Trauma Extremity Carolinas PoisonControl Jellyfish stingJellyfish Sea sting Urchin Sting barb ray stingCoral itch Swimmers stingShellCone biteFish stingFishLion

Differential         46°C)

- °F (43 °F TE 6 TE if if available 114 if if indicated if indicated

LionFish Sting Sting Ray – Cardiac Cardiac Monitor if if indicated if indicated if if indicated if indicated Immobilize Immobilize injury Pain Control Pain IV / IO ProcedureIO IV / Sea Sea Creature Protocol UPProtocol11 Identification of Urchin / / UrchinStarfish Age Age Appropriate Age Age Appropriate Immerse in Hot in ImmerseWater Hot Monitor and and Monitor Reassess Remove Barb or Barb Spine Removeor

If large Barb in thorax or Barb largeIf in abdomen stabilizeobject abdomen Hypotension / Shock / HypotensionShock Allergy / Anaphylaxis / AllergyAnaphylaxis Protocol AM 1 / PM AM Protocol 1 / 1 PM AM Protocol 3 / 5 Drowning Protocol TEDrowningProtocol 3 NotifyDestination or General Wound Care General Wound Procedure ContactMedical Control Intense localized Intense pain localized secretions oral Increased vomiting Nausea / cramping Abdominal / anaphylaxis Allergic reaction P A

     Signs andSymptoms Marine Envenomations / Injury Envenomations Marine War - Any local EMS System changes to this document must follow the NC OEMS mustbe Policy the documentProtocolNC this EMS local by followchanges OEMS Any Changeapproved System OEMS and to

O - Immobilize Immobilize injury Jelly Fish Jelly Anemone Lift away Lift tentacles Man Do Not ruborDo brush Not Previous reaction to marine to reactionPrevious organism Immunocompromised Household pet Type of bite / bite/ of Typesting organism Identification of Revised 01/01/2017

   History   Toxic-Environmental Section barbs intobarbs victim.

– hours. Bleeding may be profuse due to deep puncturedeep profuse to hours. due be may Bleeding

degrees for 30 to 90 minutes is the treatment of choice butchoice of treatmenttheis 90 30 degrees do minutes to for – 46°C), has recently been shown to be effective in pain control.pain hasbe in recently effective to 46°C), shown been

-

– TE 6 TE 114°F (43 114°F

– War: - O - hours may reveal an inflammatory reaction with swelling, redness, itching, tenderness and ulceration. itching, ulceration. redness, tenderness anwith revealmayand reaction inflammatoryswelling, hours

Marine Envenomations / Injury Envenomations Marine

– not delay transport if indicated. indicated. transport if delaynot similar effects. similar initially. initially. Any local EMS System changes to this document must follow the NC OEMS mustbe Policy the documentProtocolNC this EMS local by followchanges OEMS Any Changeapproved System OEMS and to Irrigate wound with saline. Extract the spine or barb unless in the abdomen or thorax, contact medical control for for medical control contactadvise. thorax, or in unlessabdomen the barb or withExtract spine the saline. Irrigate wound do but90 intransport.30 delaynot available water minutes hot to Immersion for if Typical injury is swimmer stepping on ray and muscular tail drives 1tailmuscularon swimmer isdrives injury and ray Typical stepping broken.isreleased barb when Venom over are1symptoms immediate Typical increases which pain wound. increased crampingand diarrhea, occur.may and muscle urination vomiting, Nausea, salivation collapse and hypotensionoccur.may Seizures, cardiovascular or respiratory Papules, vesicles and pustules may be noted and skin.bemaythe pustulesform may noted and ulcers vesiclesPapules, on occur. may vomitingor pain nausea,and cramping, secretions gastrointestinal oral Increased collapse and respiratoryspasm, follow. may Muscle cardiovascular areaquariums.theyasinpetsasinkept often saltwater home the North would this Carolina In occur typically of copiousprotruding area irrigate amounts saline. any Removeand spines with obvious immersionsoheatisin labile 110 water, venom hot The Immersion in warm water for 20 minutes, 110 for in warm 20 water Immersion (card).edge within and be may sharp aremoving useful tentacles the Shaving nematocysts cream jellyfish.thedetached to from cause if nematocysts the even rubbing or Stimulation fire pressure by nematocyst the of rubbing ornematocysts away firing. scrapping as cause will Lift tentacles contact, minutes. increasesstinging over sensation intensity are on symptoms10 Typically immediate usually occur. itching Redness and The next 24 24 nextThe amounts largewater water fresh then soapy or flushing is of Treatmentrepeating with nematocysts. and remove to tentacles withseawaterfresh area the Wash well.asnematocysts iceor firing cause willthisas Do water fresh apply not choice that nematocysts. evidence clear a demonstrate notany neutralizes Recent solution does of tenderizer have and may meat Soda Seawater, even Baking mixture seconds), and of for 50:50 30 Vinegar (immersion Coral is covered by various living organisms which are whichstructure. the dislodgedeasily from living variousby coveredisCoralorganisms symptoms if to abrasions small coral the coral causing and any little and swim maycuts Victimenter cuts may causing into Ensure good wound care, immobilization and pain and woundgood immobilization care,control. pain Ensure Patients can suffer cardiovascular collapse from both the venom and / or anaphylaxis even in seemingly minor minor in envenomations. seemingly anaphylaxis oreven and collapse both venom / the from suffer cardiovascular Patients can to moderate pain. bites stings severe Sea impart and creature of appropriate.asenvenomation theinactivation by venom the Arrest Stingrays: Lionfish: Jelly Fish / Anemone / Man / / FishJellyAnemone Priority is removal of the patient from the water to prevent drowning. prevent drowning. is water patient of to Priority the from the removal Coral: Ensure your safety: Avoid the organism or fragments of the organism as they may impart further sting / / the sting furtherfragments impart the as injury. safety: or may they organism of your Ensure organism Avoid Revised 01/01/2017

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