Heat, Cold & Environmental Emergencies

On a hot afternoon a five-year-old who has been running around outside becomes dizzy and sweaty and complains of a headache. What should you do first?

• ALet her carry on playing after a drink
• BLay her flat in the sun with her legs up
• CMove her to a cool shaded place✓
• DSit her in the sun with a sweet biscuit

Answer: The first step for heat exhaustion is to get the child out of the heat into a cool place, then remove excess clothing, cool the skin with water or a fan and give water or a rehydration drink. Keeping her in the sun, whether sitting, lying or playing, allows her temperature to keep rising. Watch her closely while she cools.

A child with heat exhaustion has been moved indoors and her outer clothing removed. Which of these is the right drink to offer her?

• AWater or an oral rehydration drink✓
• BA hot chocolate to keep her energy up
• CA warm cup of sweet milky tea
• DNothing by mouth until a doctor has seen her

Answer: Cooling and rehydration go together: the child drinks water or an oral rehydration drink to replace the fluid lost through sweating while her skin is cooled with water or a fan. Hot drinks add heat to a body that needs to lose it, and withholding fluids delays recovery in a child who can swallow safely.

You are cooling a child with heat exhaustion and giving fluids. If there is no improvement, after how long should you call 999?

• A15 minutes
• B60 minutes
• C30 minutes✓
• D90 minutes

Answer: Heat exhaustion should settle with cooling and fluids; if the child is no better after 30 minutes it is treated as an emergency and 999 is called. Waiting an hour or more risks a life-threatening rise in temperature, while 15 minutes is not long enough to judge whether the cooling is working.

A seven-year-old has been playing in strong sun. Which finding tells you this has become heatstroke, needing an immediate 999 call rather than cooling and fluids alone?

• AComplaining that her legs feel tired and achy
• BSkin that is hot to touch but no longer sweating✓
• CSweat-soaked hair and a flushed face after running
• DThirst and a request for a second drink of water

Answer: Hot skin that has stopped sweating, confusion, a seizure, unresponsiveness or a very high temperature mean the body can no longer cool itself: this is heatstroke, an emergency needing 999 and urgent cooling. Thirst, sweating and tired legs are expected in a child who has been active in the heat and are managed with rest, shade and fluids.

A child returns from a trip to the park with red, sore skin on the shoulders from the sun. What is the correct first aid?

• ABurst any blisters, apply a plaster and encourage her to drink milk
• BRub in butter, keep her in the shade and let her carry on playing
• CPut her back in the sun for a short while so the skin can harden
• DCool the skin, cover it, give fluids and keep her out of the sun✓

Answer: Sunburn is treated by cooling the skin, covering it, giving fluids and keeping the child out of the sun, and parents are told so that care can continue at home. Butter and other greasy products are never put on a burn, blisters are left intact, and further sun exposure deepens the damage.

A six-year-old has been playing outside in cold rain for a long time. Which set of signs suggests hypothermia?

• AFlushed hot skin, a headache and rapid breathing
• BItchy red patches on the hands and a runny nose
• CSneezing, a sore throat and a raised temperature
• DShivering, pale cold skin, slurred speech and drowsiness✓

Answer: Shivering, pale cold skin, slurred speech and increasing drowsiness are the classic signs of hypothermia in a child and mean the child must be warmed gradually while 999 or A&E help is sought. Hot flushed skin with a headache points to heat illness, and sneezing, itchy skin or a sore throat suggest minor illness or irritation rather than a dangerously low body temperature.

A baby in a pram has been outside in cold weather. Which finding should make you suspect hypothermia rather than simple tiredness?

• AShe is cold to touch, limp and refusing her feed✓
• BShe is warm to touch, sleepy and sucking her fingers
• CShe is rosy-cheeked, yawning and rubbing her eyes
• DShe is fretful, kicking her legs and pulling at her hat

Answer: A baby with hypothermia is cold to touch, limp, unusually quiet and refuses feeds, and needs urgent gradual warming and a 999 call. A warm, rosy or fretful baby who is yawning or sucking her fingers is showing normal signs of tiredness or hunger rather than a dangerously low temperature.

A child has fallen into a stream on a cold day and is now shivering hard in soaked clothes. What should you do first?

• ASit him in a hot bath to bring his temperature up quickly
• BRemove the wet clothing and wrap him in dry blankets✓
• CHold him close to a radiator until the shivering stops
• DRub his arms and legs briskly to get the blood moving

Answer: Wet clothing keeps drawing heat from the body, so it is removed and the child is wrapped in dry blankets in a warm room and warmed gradually. Rubbing the skin, a hot bath and direct heat from a radiator are all avoided in hypothermia because the body must be warmed slowly, not suddenly. Keep checking that he stays alert.

A child with mild hypothermia has been changed into dry clothes and wrapped in blankets, and is fully awake and talking. Which of these is appropriate to give her?

• AA warm sweet drink✓
• BA frozen ice lolly
• CA cold fruit juice
• DA glass of iced water

Answer: A warm sweet drink helps a fully conscious child rewarm and replaces energy, and it is offered only when the child is awake enough to swallow safely. Cold or frozen drinks and lollies would lower the body temperature further. If the child becomes drowsy, nothing more is given by mouth.

You are warming a child who became very cold on an outing. Which change means you should call 999 straight away?

• AHe becomes drowsy and hard to rouse✓
• BHe says his fingers are tingling
• CHe starts to shiver much more strongly
• DHe asks for another warm drink

Answer: Drowsiness, confusion or unresponsiveness in a cold child means the hypothermia is becoming severe and 999 is called while gradual warming continues. Shivering, tingling fingers and asking for a drink show that he is still awake and responsive, so warming continues; the NHS still advises 999 or A&E for any child you think is hypothermic. Keep checking his breathing throughout.

You have safely lifted a three-year-old out of a paddling pool. He is unresponsive and not breathing. What should you do first?

• AStart chest compressions straight away without any breaths
• BHold him upside down to empty the water out of his lungs
• CGive five rescue breaths and then begin chest compressions✓
• DTurn him on his side and press his back to drain the water

Answer: A drowned child has stopped breathing because of lack of oxygen, so CPR starts with five rescue breaths followed by chest compressions, while someone calls 999. Trying to drain or expel water by turning him or holding him upside down wastes vital time and is not recommended, and compressions without any breaths miss the oxygen he most needs.

A four-year-old slipped under the water in a pool for a few seconds, was pulled out coughing and now seems completely back to normal. What should happen next?

• AShe rests in the shade for half an hour and then goes back in the pool
• BShe is sent home early with a note asking her parents to watch her
• CShe is dried off, given a drink and watched for the rest of the day
• DShe is taken to hospital to be checked even though she seems recovered✓

Answer: Any child who has been submerged and needed rescuing should be assessed in hospital even if they appear fully recovered, because breathing problems can develop after an apparent recovery. Resting, drinking, watching her at nursery or sending her home miss this risk. The incident must also be recorded and the parents told.