Hypothermia

[SGL70]

In a thread started by stu1979uk: Skills to learn or improve, I suggested in a oneliner that knowledge about hypothermia is important. I thought I should offer more than a one-liner, though (Warning: Wall of text).

My personal experience of hypothermia is not that personal - I have not been afflicted myself. But two of my friends have. One went katatonic on us (we had to force him to move using our ski poles for a short while) and the other became absolutely certain that we had left him alone in the woods...he went bananas... (Short wrestling match ensued, followed by a rather long tea break).

My army training helped me and I thought I should share what I know (I have also checked the old army manuals for accuracy). It is not aimed to make anybody an expert, rather to define the battle field somewhat.

The text below can perhaps feed the nervous emotions, that some might have about going out during the white season. Don't worry. If one sticks to the basic rule: to be DRY, WARM, FED and HYDRATED you will not ever get there.


so, here goes....Hypothermia

If the body looses more energy than it can produce, you are likely to get hypothermia. It happens when you are wet, subject to lousy weather with high winds or if you are immobile. Excertion, dehydration and hunger can further fuel this. Hypothermia can even hit you when the mercury is above 0 C (!).

The first sign of hypothermia is the feeling of being sluggish and detached. As you can see from the listed Reactions below, it can be a bit hard to identify this if you do get there yourself.

Reactions

Moderate hypothermia (BT= Body temp, Celcius):
BT:35C – Heavy shivering, impaired motor skills, clouded judgement, apathy
BT:33C – Less shivering, cannot use the hands, confused

Severe hypothermia, Unconsciousness
BT:30C – No shivering, cannot walk, very confused
BT:28-30C – Weak pulse and breathing, heart arrythmia
BT:25-27C – Unconsciousness, appears dead


Actions/Treatment

Moderate hypothermia:

• Get in cover from the wind.
• Change to dry clothes or add a layer of clothing.
• If the person can hold a cup – give the person hot sweet beverage.
• If the person is”only cold”, make him/her move. Be firm. Take care though, take more stock in a person’s reactions than their statements.
• Find a warm place.

Severe hypothermia:

• Handle the person very carefully. No sudden movements.
• Examine the person in cover from the wind. Brush away any snow. Carefully remove wet outer layers and cover the persion with warm clothes, sleepingbag etc (don’t forget the head). Isolate the body parts.
• Protect from cold from the groud.
• Place the person in recovery position.
• DO NOT TRY TO HEAT THE PERSON! (Just isolation!)
• Get the person to a hospital.
• Check breathing very often

Preventive actions

Before

• Plan for regular brakes, meals and hydration.
• Check the current weather as well as forecasts.
• Make sure that clean and dry socks, shoes and insoles are brought.
• Make sure that the clothing fits the activity.

During

• Make sure to mix physical activity so that a slight excess of heat is produced.
• Adjust clothing, if need be.
• Check general condition on everybody.
• Check faces, fingers, and toes for white spots (i.e. frost bites).

After

• Check for frostbites.

Individually

• Are clothes and shoes dry?
• Can you feel fingers and face?
• Can you feel your toes? If uncertain, remove the shoes to check.

Frostbites and hypothermia can be avoided if you pay careful attention to Clothing, Hydration, Food and checking one self and others. The basic rule is to be DRY, WARM, FED and HYDRATED.


.......and btw, my command of the anglo-saxon tounge is serviceable, but it is not my native language. Furthermore, I am not a medical doctor, but this is what I have been taught.

Greger

 

[Fraxinus]

Excellent post Greger, a worthwhile reminder to us all.

A few points to note also are that alcohol and drugs can exacerbate the condition (so worth noting if someone you are with is on medication), giving someone a brandy is also not a good aid to recovery, and someone can become hypothermic even in summer.

Rob.

 

[The Lord Poncho]

Good summary - very helpful! I find it useful to remember the 'umbles' as an aide memoir to the signs of hypothermia - fumble, mumble, stumble, tumble - in order of severity. Gross oversimplification, but is nonetheless, helpful I find. On the same vain as the alcohol comment above, rubbing the casulty can also make things worse - as it brings the blood away from the bodies core to its surface, where it then cools faster.

Can be useful to prevent frostbite/frostnip where the core body temperature is not at risk though.

I've had mild hypothermia a few times (the feeling is easiest described as everything thing, no matter how small seeming to become a huge effort to do - not just physical activity - and a strong desire just to find somewhere to go to sleep), and have dealt with one particular person in the forces that had it bad (sat down in a big puddle, refused to move, started not making much sense). In that situation it was the case of setting up a basha, getting the individuals warm kit, sleeping bag and bivi bag out, and essentially making it as easy as possible for his now irrational mind to be persuaded to make the effort to get out of said puddle and into the waiting warm kit, warm drink etc.

I have heard that once you have it, you become more susceptible to getting hypothermia in the future - i'm not sure what the science is behind this, and if there is any truth in that though.

 

[rik_uk3]

Good post Greger and whilst we're on the subject... keep an eye out for elderly, single neighbours during the winter months.

 

[SGL70]

Great to hear it might be of some use!

...forgot the part about alcohol and drugs. Good that it was mentioned.

I am not sure about increased sensitivity to hypothermia once you have been there...but that is true for frostbite. After getting mild frostbitten toes when skating/playing hockey in my youth, I get frostbites rather quick nowdays. I have no real idea why it is so, though...

(I left out frostbites above, because the text already quite long)

A person afflicted by severe hypothermia can appear to be dead (weak pulse and breathing). Therefore it is important to treat a found person.

Greger

 

[dwardo]

Nice reminder. Have been to mumble and confused before now and its not fun. That was in mild but wet weather.
I find its easier to let your guard down in damp cool weather as opposed to obviously cold frosty snowy weather.

 

[bambodoggy]

Great posts from the OP and later contributors, even for those with years of experience a little reminder now and again can only be a very good thing

Thanks,

Bam.

 

[crosslandkelly]

Thanks for this timely reminder and report. And just to reiterate Riks thought to check on elderly family, friends and neighbours.

 

[Quixoticgeek]

Actions/Treatment

Severe hypothermia:

• Examine the person in cover from the wind. Brush away any snow. Carefully remove wet outer layers and cover the persion with warm clothes, sleepingbag etc (don’t forget the head). Isolate the body parts.

• 
  
  It is important when you have a hypothermic casualty that you don't just put them in their sleeping bag fresh out the pack. If you do that, all you are doing is putting a cold object in an insulated casing, you'll keep it cold. Warm the sleeping bag up, climb in there with them if you can, hug them, cuddle them, what ever is needed to warm them up.
  
  I've been mis-fortunate to suffer from hypothermia on more than one occasion, and can definitely say it is not a pleasant experience, and the best thing you can do is prevent it. Don't go all macho, don't over do it, notice the symptoms early.
  
  Julia

 

[Quixoticgeek]

Just to add, hypothermia can happen even when the sun is out and it's lovely and warm. If the casualty is wet, and there is wind, you can chill the body enough to get hypothermia, don't think of it as just a winter condition, in the middle of summer it can happen. The wet may even just be from sweat.

It's also worth being aware that when it is freezing temperatures, a casualty with hypothermia is at a much higher risk of frost bite, keep an eye on the extremities.

But above all, try to avoid it if at all possible.

Julia

 

[Macaroon]

.......and btw, my command of the anglo-saxon tounge is serviceable, but it is not my native language. Furthermore, I am not a medical doctor, but this is what I have been taught.

Greger[/QUOTE]

I know quite a few British people who could take lessons in written English from you, you write extremely well and very clearly.

A very good post which has provoked intelligent and positive responses, I've certainly taken another look at something I've ignored, so thanks for this

 

[Harvestman]

Very useful post indeed. Even if you know it all already (and I certainly didn't) the reminder is good.

 

[Paul_B]

Well I've just learnt from the OP that the one time I got it in the hills I had a BT of about 35C. Judging by my recollection of my symptoms that is. Our group had been playing around high up in the Lakes sledging in bivvy bags (orange plastic ones which got trashed) and ice axe practice. I was head to toe in Paramo and decent kit too. My mates got me down quickly to the valley out of the cold and what wind there was. Not many degrees C warmer but getting lower and making me walk along the road to the hut we were staying in warmed me up. I just found it very hard to walk and likened the feeling to being rather drunk. Being a student at the time I'd learnt by a lot of experience what being drunk feels like and IME hypothermia felt like that to me.
I've had milder cases after whitewater paddles a few times. One desperately cold new year's day paddle without gloves or pogies my hands were turned to claws and I was in a bad way at the end. Took the wife of one of our group to get me out of my cag / wetsuit and into warm clothes. My hands took an hour to become truly recovered and the pain was not pleasant.

My advice is to look after yourself in cold conditions and look after your mates / rest of your group. Sufferers really need others to spot the signs. I don't think the sufferer can spot the condition for themself.

 

[Insel Affen]

Really good post Greger and good English too!

I was taught that the best way to warm someone up was in for two people to get naked in a sleeping bag as skin to skin contact was better than anything else. Is this still the case? I must say it was used on Exemoor while we had some recruits out walking in separate groups. One kid went down with hypothermia so they got another guy naked in a sleeping bag and it had gone a long way to heat him up by the time the helicopter arrived. The doctor on board said it had worked too. Just wondering if it's a recognised method?

I liked the 'umbles' memoirs too, The Lord Poncho.

 

[SGL70]

Thanks for the comments on my penmanship. I gave the heads up as it is an important subject and that there could be some swedish in it

When treating a person suffering from hypothermia it is important to bring the core body temp up slowly. People that was shipwrecked and rescued during WW2 were often put in the boiler room to heat up. The boiler rooms did not always allow for everybody to be in there, however. The ones that was left outside the boiler rooms, displayed a much higher survival rate then the ones in the boiler room. So easy does it.

To heat someone in the woods, you do whatever you can. Skin-on-skin is very good. Not only for hypothermia, but also for frostbites.

Greger

 

[Robson Valley]

Germany, the Third Reich, was quick to realize that skin-on-skin was extremely effective in reviving pilots downed in the North Sea.
They employed rescue ship-board "ladies" to do exactly that.

The real deal is that the chilled surface blood will suddenly replace core blood and that stops your heart.
Like RIGHT NOW. You can put jam in your pockets because your a$$ is toast.

If you research the origins and research behind and beneath "Mustang" survival equipment, (Dr. John Hayward, University
of Victoria, BC/Canada) you will learn how much the WW II German experience (for better or for worse) has contributed to the survival of people
living and working on the sea, ever since. Those people did not die in vain.

John constructed an outdoor bower, 100m long. A spray tunnel to walk in, back and forth in the winter, until you fell down from hypothermia.
With a catheter in your heart, he had a tank to revive you. Never lost a volunteer (and they were LINED UP for bragging rights.)

The work goes on. His clothing designs suit the public, the industry and the military around the world.
Forgive me. This popped into my head. We drifted apart as so often happens.

 

[Gimli]

Good work.

I hope you dont mind me adding a we bit to this, The Swiss Society of Mountain Medicine simplified hypothermia in the way that you have done as it makes diagnosis and treatment easier. http://www.mymedal.org/index.php?n=Military.340110. This is very similar to the OP.

 

[SGL70]

...by all means, add away...

Interesting link, that one. Neat table!

Cheers,
Greger

 

[Seabeggar]

If they are hypothermic, but still able to walk with a bit of encouragement, its generally worth keeping them moving. Obviously depends on the weather, circumstances and rescue options available, but keeping moving will rewarm, sat still will likely lead to further cooling unless you have adequate shelter.

 

[Teepee]

Nice post Greger. A good simplified summary.

2 great videos from Dr Gordon Giesbrecht from University of Manitoba on self rescue, rescueing others, and lifesaving techiniques after an icy dunk;
[video=youtube;5gOW8ZaYqHA]https://www.youtube.com/watch?v=5gOW8ZaYqHA&feature=yo utu.be[/video]

Part 2 linked to in the video.