Environmental emergencies arise from extremes of temperature, water immersion, and encounters with venomous animals and insects. Heat exhaustion presents with heavy sweating, weakness, cool and clammy skin, and normal-to-slightly-elevated temperature, and is generally managed by moving the patient to a cooler environment, removing excess clothing, and providing fluids if fully alert. Heat stroke, by contrast, is a life-threatening emergency characterized by hot skin that may be dry or moist, altered mental status, and very high body temperature; immediate treatment focuses on rapid cooling by removing clothing, applying cool water or ice packs to the neck, groin, and armpits, administering high-flow oxygen, and rapid transport. Hypothermia is treated by removing wet clothing, applying passive rewarming measures, and handling the patient gently to avoid triggering a fatal cardiac arrhythmia. Frostbite, the freezing of tissue, is managed by protecting the affected area, avoiding rubbing or massage, and not attempting rewarming if there is any possibility of refreezing or if direct heat sources could cause further damage.
Water-related emergencies require special attention to suspected spinal injury. A near-drowning patient must have airway and breathing supported with high-flow oxygen, and if the mechanism involves diving or unknown circumstances, full spinal precautions are observed because of the potential for cervical spine injury. Venomous snakebites are marked by puncture wounds, localized pain and swelling, discoloration, and sometimes systemic symptoms such as nausea and weakness. Field treatment focuses on keeping the patient calm and still, immobilizing the limb at or below heart level, removing constrictive items like rings or tight clothing before swelling progresses, and rapid transport; the EMT should not attempt to capture the snake, apply ice, or use a tourniquet. Insect stings that trigger anaphylaxis are treated with the patient's prescribed epinephrine auto-injector along with high-flow oxygen and rapid transport, while non-anaphylactic stings are managed with basic wound care and monitoring for delayed reactions.