Cold Water Clinic follow on - hypothermia

[kattenbo]

During yesterday's Cold Water Clinic a couple of questions came up on hypothermia recognition, symptoms and treatment. While some responses were given, I thought it would be worthwhile to provide some pointers to sites, etc. that had additional information. Keep in mind I am not a medical professional - the info below is all from listed sources.

One of the reasons this info is important is that the treatment is significantly different when you transition from mild to moderate/severe hypothermia. Not to put to fine a point on it, what is a good treatment for mild cases (shivering, etc.) can potentially kill someone with moderate to severe hypothermia.

The good news is that NSPN winter paddling protocols mitigate against ever getting to the point of someone experiencing significant hypothermia. Paddling in groups with good rescue skills, dressing for immersion and having a culture where peer pressure is focused on communicating any discomfort early goes a very long way to precluding problems.

Here's a quick summary extracted from the Outward Bound Wilderness First-Aid Handbook:

The book describes 3 stages - cold response, mild hypothermia and severe hypothermia.

Cold response is the first stage and is essentially where "the person (not yet a patient) feeling uncomfortably cold...". Slight or obvious shivering may be present and the skin may be pale and cool. Treatment is to get into warmer dry clothes, eat and exercise. Eating is an essential part of the treatment - you need to have fuel to burn to make the calories needed to warm up. Side note: If folks on a trip are paying attention, you should never get beyond this point short of a capsize.

Mild hypothermia is signaled by "mental status changes and shivering. The patient may be lethargic, withdrawn, confused or exhibit personality changes." Look for pale cool skin, dexterity loss and mild to severe shivering. As long as the patient is awake and can cooperate, try a combination of heat retention and heat production. Heat retention includes dry clothing, wind and vapor barriers, insulating from the ground, getting the person into the sun, near a fire, group hugs, etc. Heat production is food and fluids, then exercise. Start with high sugars, then move to more complex carbs. Exercise the well fed person (fuel first, then exercise) if it doesn't expose them to more cold.

Severe hypothermia symptoms may include personality changes, hallucinations, confusion and decreased/gradual loss of consciousness. The patient will not be able to cooperate with treatment. This is a major emergency - a cold heart is highly subject to disruption. Call for help immediately. Trying to warm the person through exercise, massage, etc. is listed as dangerous. Suggestions are to wrap the person in insulation a (including from the ground) very gently, including a vapor barrier. Keep them horizontal - blood vessels have lost their ability to constrict and will allow core blood to escape if the person is held upright. If absolutely necessary to transport, then do so with the person horizontal.

Here are some of the links and other info (in no particular order). Google "hypothermia" for more.

http://www.hypothermia.org/fieldchart.htm: A good thermometer, based description of symptoms and treatments. This site is pushing an Air Rescue piece of equipment, but the info is good.

http://www.outdoorplaces.com/Features/Moun...ermiatreat.htm: General article on treatments, but light on how to judge the stage of hypothermia.

http://www.bbc.co.uk/health/conditions/hypothermia1.shtml: Provides a good description of symptoms including "the 'umbles" and of treatment for mild hypothermia. Severe hypothermia is "get medical aid".

http://www.bt.cdc.gov/disasters/winter/gui...sp#hypothermia: Short bit from the CDC.

Hope these serve as helpful pointers. As I said at the start, I am not a medical professional, so please do some research on your own so you are comfortable with the information.

Keith

[Guest _rick]

Keith brings up good points. Of interest or not that the number 3 cause of death in cold water immersion is hypothermia, number 1 and 2 are cold shock and swimming failure.

The last cause of death needs to be looked for if you succeed in recovering a cold water immersion victim that is collapse caused by the body response and attempted recovery from immersion.

Remember someone exposed to 60 degree water unprepared may not be able to assist in their own rescue. While I watch my daughter swimming in a wet suit in 52 degree lake water.

[Kevin B (RPS Coach)]

Keith,

Many thanks for putting that information together.