👤 By the CinnaEMS Content Team🕐 Updated 2026-09-27🏷️ Patient Treatment & Transport🔖 Free to read, print, and share
Also known as: heat stroke · heat exhaustion · hypothermia · frostbite · drowning · bites and stings · lightning
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Use this quick-reference guide to recognise, treat and hand over Environmental Emergencies on the NREMT and on the call. Keep it handy during review and on exam day!
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📒 The 1-minute cheat sheet
📌 Heat
Exhaustion: sweaty, alert
Stroke: hot + altered
Stroke → cool on scene
📌 Cold
Remove wet clothing
Handle gently
Frostbite: don't rub
📌 Water / Lightning
Drowning → ventilate early
Lightning: arrest first
📚 Environmental Emergencies — full study notes
The cheat sheet above is your quick recall card. These notes go deeper — what it is, what to do first, what changes the plan, and what to hand over.
Environmental emergencies test one priority each: cool the hot and altered patient, handle the cold patient gently, and ventilate the drowning victim. Recognizing heat stroke versus heat exhaustion is the classic question.
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Key points
Understand these first
Heat exhaustion: sweating, weak, dizzy, mental status normal — move to cool and rest.
Heat stroke: altered mental status with high body temperature — rapid cooling on scene.
Hypothermia: remove wet clothing, insulate, handle gently to avoid dysrhythmia.
Frostbite: no rubbing and no rewarming if refreezing is possible.
Drowning: open the airway and ventilate early — hypoxia is the cause of arrest.
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Treatment priorities
What to do, in order
Heat stroke: cold-water immersion or aggressive cooling — do not delay for transport.
Hypothermic arrest: take longer to check for a pulse; start CPR if none.
Lightning with several victims: resuscitate those in arrest first (reverse triage).
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Red flags — report now
Escalate immediately
Heat illness with confusion
Shivering that stops as temperature keeps falling
Snakebite with spreading swelling
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Patient teaching
What patients must know
Sweating does not rule out heat stroke — mental status is the dividing line.
❓ Environmental Emergencies: NREMT FAQs
What are the priority actions for Environmental Emergencies in the field?
Heat stroke: cold-water immersion or aggressive cooling — do not delay for transport. Hypothermic arrest: take longer to check for a pulse; start CPR if none. Lightning with several victims: resuscitate those in arrest first (reverse triage).
What findings in Environmental Emergencies change your plan or your transport decision?
Heat illness with confusion. Shivering that stops as temperature keeps falling. Snakebite with spreading swelling.
What do I need to know about Environmental Emergencies for the NREMT?
Heat exhaustion: sweating, weak, dizzy, mental status normal — move to cool and rest. Heat stroke: altered mental status with high body temperature — rapid cooling on scene. Hypothermia: remove wet clothing, insulate, handle gently to avoid dysrhythmia. Frostbite: no rubbing and no rewarming if refreezing is possible.
What should the crew communicate or document for Environmental Emergencies?
Sweating does not rule out heat stroke — mental status is the dividing line.
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Quick Tip
Heat exhaustion: sweating, weak, dizzy, mental status normal — move to cool and rest.