Okay, now I am going to assemble a hypothermia kit, including some instructions on when and how to deploy it aimed at me as I slip into hypothermia and at a relatively uneducated helper [no big words, etcetera].

Thoughts, oh mighty brain trust?

A hypothermia kit.

1) A dry bag to carry the following items.
a) Insulation layer consisting either a set of bivi trousers and Jacket or Down Sleeping bag specified to the highest rating for the weight with the possible addition of a lightweight waterproof bivi cover such as a Heat shields Bivi Bag.
b) A neoprene covered flexible water carry system with a drinking tube such as a 2 Litre Camelbak Unbottle.
c) A compact fast water/beverage stove system such as a Jetboil Flash or Primus Eta Solo etc.
d) Beverage mix such as hot chocolate or soup sachets etc


Instructions.

Get out of wet clothing.
Get into dry bivi sack and bivi clothing/sleeping bag.
Heat some water using the stove until it is just too warm to dip fingers into - then add some beverage mix such as hot chocolate or fruit flavor mix. Pour into the Unibottle then place into the bag/bivi along with the patient to warm torso area. Get patient to slowly sip on warm liquid contents.

Stove, sleeping bag, and shelter are all good. Hot sugary drinks are also good. You might add a little solid food to that. Yeah, I know "food isn't a priority in a survival situation." Well, maybe that's true in warmer weather, but in winter calories = warmth. Hard to stoke the furnace if you've got no fuel.

For that stove, if you're going out in temps less than 20F, then forget the Jetboil or Eta Solo. Even in the 20's upright canister stoves won't work all that great. Go with either an inverted canister stove, a specialized cold weather gas stove, or a liquid fueled stove. I've got recommendations on my blog for lightweight winter stoves if you're interested:
MSR Windpro (inverted canister)
MSR Simmerlite (liquid fuel)
Coleman Xtreme (specialized gas)

HJ

Good stuff as always, Grey Man.

Jim, been loving your stove posts!

Clothes
Insulation from more cold
Hot liquids
Multiple hot packs to "wear"
Easy to eat and absorb energy food

??

Good lists so far. What sort of size / weight constraints are you looking at for this kit?

If compact is a priority maybe consider a candle lantern with waterproof matches or a bic for a quick source of heat along with a some basic fire starting materials and a heatsheets blanket or bivvy. Additional heat from chemical hot packs would probably be good also.

Clothing is tough trying to keep things small and light but maybe keep a pack of light weight long underwear in a ziplock/dryback with the rest of the kit and a decent hat.

Personally I'd rather have the stove and the sleeping bag (actually I do have them in my car) but I can think of some circumstances where it just wouldn't be practical to carry that much.

-Eric

Everyone above,has most of it covered Well!I'll add-Military Poncho/Woobie:Poncho Liner,Drinking Water of course,A few tins of Brisling Sardines,Spam Packs,Vienna Sausages for Instant Protein/Fat absorbtion.MRE Heater&Instant Jello for a Quick Charge,Hot drink.Snickers/3-Musketeers bars for present/future Malady.Silk Top,Bottom,Socks,gloves,Balaclava-Can all fit into a 1-Gal.Freezer Bag.Couple of Camp Towels.Faith in Yourself!

My current thoughts, based on your suggestions in part:


Towel: super absorbent and compact

Clothes: ultra thin wicking poly/merino wool:
socks
pant, preferable footed or stirrup
top, preferably hooded

insulation layer, high tech and thin:
top to toe as above

ultralight hooded rainsuit

ddry footwear ?water socks?

Insulation from more cold
bivy heatsheet
ultra light ground pad?

Hot liquids
?self-heating soup

Multiple hot packs to "wear"
armpits, groin, back of head?

Easy to eat and absorb energy food
self-heating stew
chocolate ?

Wetfire tinder and stove

Sparkie one-handed blast match

Water:
Nalgene bottle "wearing" a TI cup

Can "wear" the bivy at need as an outer layer

Maybe the size of 2 breadboxes?

In a dry bag inside the smallest workable daypack?

What you are proposing is excellent - for some conditions, not so much for others. Preventing and treating hypothermia is all about skills and knowledge, and not so much about "gear."

The classic PSK and "ten essentials" equipment lists are basically all about hypothermia and its evil twin, hyperthermia. Interestingly enough, staying hydrated is critical to avoiding both states.

What you need can vary from something the size of a belt pouch to the entire contents of a 6,000 cu in pack. Basically you want clothing and shelter adequate for conditions, and then just a little bit more. My irreducible minimum extra clothing that I have always carried for years is a light coated synthetic hooded shell. The present version weighs all of 4 oz, but it will provide crucial wind proofing and allow rewarming. It doesn't get used very often, but when it is employed, the circumstances are memorable.

The ability to provide hot food and drink is important; again, my minimum kit can fit inside a sierra club cup, but when it gets cold I carry much more. Life as we know it is impossible without the proverbial nice cup of tea.

Remember -"There is no such thing as bad weather, only bad clothes." Another line I just ran across from my bible, "Medicine for Mountaineering" by Wilkerson - "A human's greatest protection against the cold is his intellect."

Read extensively in the literature on hypothermia and/or take a good first aid course.

Hypothermia is often equated to being extremely cold and wet with the usual scenario of a person being dunked in icy cold water or caught out in unfavorable wet/cold weather.

The oft missed and more common causes of hypothermia is simply being tired, hungry, unhydrated and under dressed in temperate weather....along with having an unhealthy "go fever" attitude.

As I have mentioned previously, hypothermia can occur when the temperatures are in the high 60's to low 70's F and it is important that others in your group, are knowledgeable in the early signs of hypothermia and react proactively when somone shows they are in these early stages.

All too often, the hypothermia victim does not acknowledge/denies that he or she is slowly losing body temperature and hypothermia insidiously slips in...at which point it may be too late to treat with your aforementioned hypothermia kit and the person will require a quick evac to medical facilities.

Isn't the "After-drop" mentioned at: http://www.hypothermia.org/hypothermia.htm caused by cool blood returning to the core and re-cooling it, causing a relapse after hypothermia treatment has begun? "Avoid having the victim assist with their own rescue! Muscular activity by the hypothermic victim pumps cold peripheral blood from the arms and legs into the central circulation causing the core temperature to drop even further." A hypothermia kit would need to account for this issue.

good suggestions above. I would add that the stove should be really simple to fire up - anything remotely confusing or fiddly won't happen when you are cold and confused.

Chemical heatpacks are a good idea imho

What hikermor and teslinhiker write about hypothermia and hyperthermia ring true to me - and you don't want to leave yourself in either scenario with relatively uneducated helpers. In Boy Scouts we use the first few hikes to educate and to assess younger Scouts along the trail - often enough you find a poorly insulated Scout (usually outfitted in sub-par gear by well-meaning parents) who struggles with early hypothermia along a wet hike. Cold wet feet, soaked to the bone, usually they can keep moving and generate enough heat to fend off affects, but they don't enjoy it, or the hike - and inevitably they would break down and begin to lapse into serious trouble if left untreated. And on one hike in Eastern Washington I found myself begin to experience hyperthermia after struggling up a steep arroyo behind more fit Scouts. The best hypothermia kit and treatment is early intervention - stopping, addressing insulation, adding water and food, give the subject some rest, then move along at a slow-moderate pace, and reassess down the trail. If you don't catch it early, break out sleeping bags, shelter, and assign some tasks, such as boiling hot liquid and prepping a bit of food, while more experienced adult leaders and Scouts see to getting their friend out of wet clothes, into dry if possible, and wrapping them up, one sleeping bag inside another, burrito style. Insulation will rapidly warm their core, and the subject should begin to revive. Wrapping a hypothermic victim is easy enough to do, and can be practiced by Scouts at a Troop meeting. When they know what to do, they carry that knowledge with them forever, and can even improvise for self-treatment if out hiking alone.

Hyperthermia is another subject, but just as important. I've had my brain heat up and now look out for symptoms in others on outdoor excursions, and kids in particular aren't quite as witting as to how thin the line can be before the effects of heat exhaustion can occur.

Meet Hyper and Hypo, the evil Thermia twins. They both begin their assault on your body by attaching your mental faculties, so that you are stupid, just when you need to be smart.

Nice, this should become part of your sig!

Very well said Lono!

I had a chance today to speak to my buddy, and it is clear I was more out of it than I recall. He says, for example, that I was in the water for about 20 minutes, while my recollection is 5 to 10 tops. He also recounted some of our "conversations" in which I attempted to take part; funny now, then not so much.

With this new information, I think it may be critical to simplify things so a dumbed-down brain has a better chance to make the right moves. Maybe forget the nice-in-theory layered clothing and substitute just a heavy, hooded sweat suit and thick socks. Dry, change, get into the bivy, and get core temperature back up with heat packs, hot food, and hot drink.

If I was traveling a lot in very cool weather, I would try and save up and buy what is below. Very compact with a purge valve on the water shed bag. I know it's expensive but what good is money if you don't make it. All have a lifetime warranty and your done. This is just a idea thrown out, you could do the same with lots of cloths for significantly cheaper, but for space, weight and reliability it's a idea. You could substitute with a sleeping bag but you won't be mobile. Anyway just a thought. This is one of those kits that there is no fuel to go bad,no fires to build, water doesn't affect it as long as it is in it's bag (300 foot rated) simple at 3 items, throw it in the car, pack or whatever and go. I use their Expedition Parka before with only a t-shirt on at 18 degrees and was not even remotely cold. Anyway just a idea that's all.


1. http://www.canada-goose.com/products-2/arctic-down-collection/arctic-rigger-coverall/

2. http://drybags.com/mm5/merchant.mvc?Scre...ry_Code=Duffels

3. Good beach towel to dry off

Try here. These guys are hardcore racers.

http://www.watertribe.com/Magazine/Y2002/M12/SteveIsaacMakeAHypothermiaKit.aspx

Jello.

warm and drink like hot coco. be sure to NOT get the sugarfree version.

Any discussion of hypothermia gets me thinking of this:

http://www.kingkong.demon.co.uk/gsr/fire.htm

Loss of fine motor control is something that should be considered when selecting items for the kit.

Hypothermia is so difficult to spot in oneself or even recognize in others. Far better to avoid it than to try to treat it.

Which is why a kit to deploy when you do recognize or spot it seems like a good idea.

Truth be told, there are some very well documented symptoms to watch for in people who may be declining into a state of hypothermia. These symptoms are fairly easy to spot even for non-professionals.

Most times if you are outdoors with family or friends, you already have a good baseline history of their normal behavior and so it becomes readily apparent when they start to show abnormal symptoms that you must heed and take immdiate action to treat as again, most people will not acknowledge or deny they are slowly slipping into hypothermia.

I have only seen one very serious case of hypothermia and it was not pleasant experience. Since then, I am very aware of the symptoms and is something I keep a very close eye on when we are out enjoying the outdoors.

1) Avoid further cooling (get out of the water, get dry clothes, wrap in a vapor barrier (plastic, bivy bag, whatever). I think all those tricks are pretty well covered. Myself, I'd like to advocate bringing a bivy bag. Change clothes, stuff in the bivy bag, then proceed.

2) Bring a thermos of your prefered hot bewerage. I'd suggest you stay away from coffee for this purpose. Tea is very good, but basically any hot liquid will do. Including plain hot water.


Those two steps can usually be achieved within 2 minutes (although sometimes not, as you experienced yourself - BRRRR!). Making a fire - which includes gathering fire wood - requires time, manpower and some skills. Much better to IMMEDIATELY excercize point 1) and 2) and go from there.

What you do next will depend on the situation. I'd say the first options to consider would be making a fire, self-extraction and getting outside assistance. And you can do at least 2 of those 3 simultaneosly.

I am confused by 'carry a kit'. It is standard amongst those going into the wild to wear clothing to keep you comfortable whilst on the move and carry kit that will protect them in the worst weather you are likely to encounter.

A person has a duty of care to themselves to be correctly equip themselves for the conditions. And, it makes far more sense to avoid environmental injuries than to try and treat them.

Despite what has been said, it is hard to recognize hypothermia in oneself and difficult to recognize it in others. The fact is if one of your group is showing signs of hypothermia others in your group including yourself will have some degree of hypothermia too.

Knowing the signs of hypothermia from a book and actually recognizing hypothermia in a person are two separate things. As with most things, experience is key. The more you go out in all weathers and experience its effect the better you will recognise it. But, there have been many very experienced people with the correct equipment that have succumbed to hypothermia. Look at the data collected by search and rescue organisations, hospitals, coroner reports and military reports to see this is the case.

If one of your group shows any of the above signs suspect hypothermia, stop, assess the problem, look for or construct shelter. If one person has hypothermia assume that others in you group are in the same condition. Arrange evacuation as soon as possible. Do not try to self extract, you are likely to send the victims heart into ventricular fibrillation.

Mild Hypothermia

• Get victims into shelter and out of wet clothing and into dry warm clothing
• If no shelter is available do not remove wet clothing but put warm insulating layers over wet clothing
• Add windproof/waterproof layers over insulating layers
• Insulate the victim from the ground with a kip mat, clothing or rucksack
• Get group together in a huddle to share heat if possible inside Bothy bag or tent fly sheet
• If conscious and able to swallow without difficulty give warm sweet drinks and sweet easy to digest food such as sweets, chocolate or sugar. Mix equal quantities of milk powder and sugar with water into a thick liquid paste.

Moderate or Severe Hypothermia

• Keep the victim still and laid down horizontally. Do not move unless really necessary as this may cause the heart to go into ventricular fibrillation, if you need to move them use a spinal lift or immobilise them to a back board
• Is semi or unconscious place in the recovery position
• If breathing very shallow give gentle assisted breathing
• If no breathing or signs of life give gentle rescue breaths via mouth to mouth, you breath will help to warm the victims lungs do not use a handheld resuscitator, do not give chest compressions you may send the heart into ventricular fibrillation.
• Place hot water bottles and or heat pads against arm pits, upper abdomen, neck and groin. Don’t place next to the skin to stop burns.
• Lightly cover nose and mouth so expelled breath warms and moisturises air as it is breathed in.
• Carefully warm shelter with stove but be mindful of carbon dioxide poisoning, make sure you have adequate ventilation

If unconscious or no signs of life

Check for breathing for one minute
If very shallow faint breathing give gentle assisted breathing
If no signs of breathing give gentle rescue breaths but do not give chest compressions
If chest compressions are given they must not be stopped until victim is re-warmed and in medical care.

Its good to carry spear clothing, sleeping bag, blizzard survival bag and a bothy bag big enough to cover everyone in your party.

Part of this post is from a post I made on another forum http://www.wildsurvive.com/outdoor-camping-forum/index.php/topic,4965.msg212645.html#new

Methodologies to stop the progression of hypothermia do require some additional kit such as a waterproof clothing and high thermal insulation to deal with the conditions that can be expected. As Ray Mears rightly points out the most dangerous temperatures for hypothermia exist where there is liquid water present (which can remove heat from the body much more efficiently) especially combined with wind chill can rapidly cause on the onset of hypothermia. So materials such as Goretex shell clothing and bivi bag etc combined with either down or primaloft insulation and the ability to produce warm and nutritious drinks and food are required. The signs such as shivering, slurred speech, fuzzy thinking and lack of hand dexterity (such as not having the ability to get a match out of a box of matches) are indications of the onset of mild hypothermia. The number one rule of not getting clothing to wet out in cool/cold conditions in the first place should be taken seriously and if this was unavoidable then remedying this situation should be a number one priority.

http://www.youtube.com/watch?v=c_Vxxbh6Czg

One contention I have with what you have advised is regarding chest compressions. While it is true that rough handling of a hypothermic patient can send them into Vfib. The lack of a pulse should cue you to immediately perform chest compressions. Treatment for a pulseless victim due to hypothermia (I am not referring to cases of treating a near drowning victim) is no different than that of someone in cardiac arrest due to an MI. If the heart is not beating, you are not going to cause any more harm by performing chest compressions. Dead is dead and waiting for more advanced medical care before performing chest compressions is not going to help unless they are going to be there within a few minutes of cardiac arrest.

As when to stop- if you can perform chest compressions until advanced medical care that is great, but the reality is if you are much more than 15 minutes from advanced medical care (ambulance-medic unit and/or hospital) there is little chance you will be physically able to perform effective chest compressions much longer. Other EMS providers may have a different take, but the above is my experience.

Pete

Thanks for your reply Pete, I hear what you’re saying and as a paramedic you are far more qualified than I am.

The reasons I say don't give chest compressions is because the protocols say if someone is not breathing properly start CPR. With hypothermia a person will not be breathing properly, they may be taking only one or two breaths a minute.

The chance is that a hypothermic person with a slow breathing rate the heart rate will have significantly slowed and not detectable for the average first aider. Hypothermia is not enough to send a heart into Vfib so there is a high chance the heart will be functioning normally other than very slowly. In a hypothermic state it is far better for heart to work slowly than go into Vfib.

As a paramedic you are far better placed to monitor what the heart is doing with help to a 12 lead ECG but for the average person we can only look at breathing as a clue to whether to start CPR. Checking for pulse is not part of the protocols anymore and even if it is someone in deep hypothermia, it is very doubtful if you would feel such a slow weak pulse.

I have given CPR on more than one occasion and I know how emotionally and psychically tiring it is. One would hope you’re in a group and other in your group are in a position to take over the cpr. Whilst in Kenya I and 2 other team mates gave CPR to a 3rd team mate for over 12 hours waiting for a helo to come and carry out a casvac. Once started if you have the resources to continue CPR until the casualty is out of your care.

The information I posted is based on the UK and European First Aid Protocols but I believe they are practically the same as yours in the States.

Actually, I am not responding as a paramedic with ALS equipment/medication, but as a first line BLS responder. Cardiac arrest will occur post respiratory arrest. If the patient is not breathing adequately and the heart not circulating oxygenated blood sufficiently for adequate perfusion, cardiac arrest is inevitable. While rescue breathing may provide air exchange within the lungs, if the oxygenated blood is not circulated to heart, which requires oxygen for metabolic function, the heart muscle becomes irritable, leading to Vfib and eventual asystole.

Pete

What was the outcome?

Pete

On this occasion he lived, it was not due to a heart condition but from toxins from mutable hornet stings. We thought he was a goner but we worked on him through the night until a helo could get to us in the morning. In that time we managed to cut an LZ too so it was one hectic night. We had conversations on whether to give up or not but as a team mate we just could not give up.

As far as I am aware, the longest recorded time cpr has been given was for 3 days, carried out by a special forces team. That is what I was told some years ago, sadly i do not know the details.

I bow to your steadfastness that was quite a feat. Usually, the buildup of metabolic toxins and development of metabolic acidosis precludes a positive outcome over long periods of CPR without some type of pharmacological intervention.

Pete

Thanks. It was not a case the medics arrived and gave him a shot of adrenalin and he was up and running around. He was left with some disability.

I do know if he was not a team mate for around 3 years but had been a stranger we would have gave up on him a long time before.

I agree but hypothermia slows this process down a lot, hence the phrase "they aint dead until they are warm and dead"

Cardiac arrest is likely to occur below 25C. The coldest survival from hypothermia is 13.7C that is between 12c and 4C degrees below medical induced hypothermia.

Do you have a reputable/verifiable link in regards to this?

No disrespect, however I find this difficult to believe (and I may be totally wrong). Over the years, I have witnessed quite a few people who were treated and or rescued off mountains etc due to mild and intermediate stages of hypothermia while others in our group...or other groups were all fine and were able to continue on for the rest of the day(s) without any signs of hypothermia.

look at any mountain leadership or search and rescue hypothermia training you will hear this. But if it is not true it is still good advise to follow, if one has gone down there is a high chance others will too.

Thanks. That is interesting. I'll pose this question next weekend. A bunch of us are going out on a mountain snowshoeing clinic (depending on weather and avalanche conditions) at which there will be some SAR people attending who are always open to questions.

the 1964 Four Inns Walk demonstrated this quite nicely. 3 died and 4 rescued in critical condition and 211 had to be assisted off the hill.

Speed of complete response is my reason for putting a kit together.

I had not considered carrying self-heating consumables because I always have the ability to make fire several ways, usually a stove, at least one cooking vessel, and plenty of snacks and nutricious food that can be heated or cooked. But all that take time to find, set up, cook, etcetera.

I had not considered carrying a towel, dry clothes, heat packs, and a bivy in one package. I usually have all of that stuff but in different places in my gear. It would take time to find and deploy each of them.

I had not experienced how much slower thought processes and physical actions became when hypothermis began setting in. Response simply takes more time, and at some point I can see you could just run out of time.

This all is given more emphasis when you are alone, as am I often, or when you may need to depend on someone else who may not really know what to do.

So, now I am resolved that in situations where hypothermia is a serious risk due to weather or water, I will carry a hypothermia kit with all the stuff discussed in one dry bag labeled conspicuously "HYPOTHERMIA." I hope it never gets used, but whether I deploy it for myself or another, I want it to be quick and easy.

One problem with hypothermia is it affects your dexterity. This can be used to your advantage by giving you a good way to check if you are starting to show signs of hypothermia.

It is quite simple and easy to remember. Touch your thumb to the tip of your little finger and ring finger. If you can’t do this it is time to stop, find shelter, get fluids, simple and complex carbs in side yourself and get warm.

If you can’t do this simple test then you are going to start to struggle to do simple things like light fires and turn on cookers. Once you have lost the manual dexterity you are on a slow downward slid. You need to avoid this at all costs.

Disposable heat pads are great providing you have the dexterity to remove them from their packaging, use your teeth. They activate automatically once exposed to air. Shove them under your wrists, armpits, around your neck and in your groin. These are areas were they can heat the blood going back to your heart with the minimum of insulation from body fat. They provide heat for between 10 and 12 hours depending on which product you buy. I would highly recommend them.

I can highly recommend Blizzard Survival Bags, if you don’t intend to carry a sleeping bag. I know many people on this forum do not like them but that is because they have very little experience of them. The fact that most mountain rescue teams, search and rescue teams, military search assets in the UK and Europe uses them suggests they are good bits of kit. I have personally spent many nights out in all weathers in a Blizzard Bag and have never been overly uncomfortable; in fact I am surprised how warm they are.

If you only plan to make day trips it is impractical to carry a tent, the best compromise is a Bothy bag. These work best if used as a group shelter but combined with a blizzard bag or something similar they are very effective at protecting you from the elements. These have not found favour in the states until relatively recently. US climbers who climb world wide with European climbers discovered how versatile and effective they are. Understandably these climbers took them back to the States and they are slowly becoming more accepted by the rest of the outdoor community.

Bothy bags have been attributed to countless lives saved across Europe. An excellent bit of kit which I never leave at home.

I apologize in advance for a long and slightly off-topic post.


The first part of this statement possibly has some validity but the way to deal with early recognition of hypothermia is to assume that any presentation of hypothermia-like symptoms is hypothermia. Treating someone for mild hypothermia will not hurt them at all and could prevent the progression to moderate or profound hypothermia. Symptoms of hypothermia are not unknown and have been well presented in prior posts.

To address the second part of this statement, consider some examples.

The first examples are cold water immersion or a crevasse fall. If only one person in a group gets wet or falls in a crevasse why would anyone else be cold?

Another example is a cold/cool weather environment conducive to hypothermia. If a group member exercises poor self management by failing to eat, drink, stay dry and dress properly and becomes symptomatic of hypothermia why would others in the group who took care of themselves be cold?

Saying that, if one then all, is a dangerous mindset, particularly for a group leader, since judging anyone else's condition by your own does not work. What if you are not at all cold and symptomatic of hypothermia and then say that no one else could be either and ignore someone who is symptomatic?

I think it is good to say, however; that if one person in a group is symptomatic of hypothermia then conditions exist that can lead to hypothermia in others and people should be careful to exercise good self management.

My experience with cold injuries/illness comes primarily from more than a dozen years as a full-time mountaineering/climbing guide in Alaska and the the Pacific Northwest during which time I treated people in the field with mild to severe hypothermia. As a side note, I too was taught by my physician advisors not to perform chest compressions on a "cold" patient.

I guess a Blizzard Survival Bag has its place for cold weather injuries above 10C otherwise I just don't believe the marketing hype. The Tog rating (uncompressed material) is around 6-8 Tog, this is a summer bag rating. For hypothermia victims, where thermo regulation has become erratic, in a just above freezing environment (0-5C) then even a substantial 1.2-1.5kg High spec Down bag (10-12 Tog) might not cut it, to provide enough thermal insulation to negate the bodies continuing heat loss. Also it should be pointed out that wet clothing may have been removed requiring an even more effective cold weather bag.

http://www.blizzardsurvival.com/

The companies marketing is suspect, with many dubious claims IMHO.





For days trips I also like to take along a Thermorest Lite Seat as well to stop the backside from freezing whilst sitting in snow or on wet cold ground. Bothy bags are very useful allowing groups to sit together and prepare warm drinks and food in their own warm and cosy micro environment once the Gas stove has been lit in the centre whilst the rain, snow and wind blows about outside.

I agree, your right and you have worded it far better than I have. But, novice groups like those from youth groups that are far less experienced, less well equipped and often have targets set on them such as getting to such a location to camp or to meet the coach home, are often the type of groups that see multiple cases of hypothermia including the person acting as group leader. They often don’t recognise hypothermia signs and this can be made worse with a drop in the groups morale and everyone climbs inside them selves and don’t speak to each other. The group will often spread out over a distance. Although training of these groups has become much better and with modern materials, clothing systems have become a lot better so hypothermia is becoming less of an issue for these sort of novice groups.

I am glad to hear you were taught not to perform chest compressions. I was starting to think the differences between our different protocols were miles apart. It seems they are not.

While I have not put one together yet...I was going with the Watertribe link when I do. All wrapped up in one package (maybe vacuum packed with LARGE tear strips). Vapor barrier to start heat retention, heat packs, gel shots, and probably a tea light with lighter or more probably easy to strike matches. All sized to fit in a cargo or life vest pocket.

In a dunking situation, getting the vapor barrier on is the largest step in recovery as it kills the evaporative cooling immediately. Heat packs are tear and use (i.e. immediate). Gel shots for carbs, and once you start functioning, a tea light between your legs (remember to vent your vapor barrier) for extra heat input.

All the insulation in the world only retains the little heat you are loosing. If you are dunked (cold water or not) it is far more efficient to use external heat to put heat back in your body, rather than rely on capturing your own heat.

Next step, add insulation on top of your vapor barrier.

Cavers routinely carry one or two lawn and leaf sized garbage bags in their helmet. Getting chilled, put one on, and in the old days, put your carbide lamp between your legs. Two layered works even better. Just remember to vent and be careful of the open flame.

Bill

Survival equipment is a compromise. If I had some one with hypothermia I would want the equipment and training to carry out extracorporeal circulatory rewarming, including peritoneal lavage, bladder irrigation and cardiopulmonary bypass; but this is totally impractical and well beyond my skill level. I have to make a compromise to try and stabilise the casualty until he can be evacuated to a facility that have this equipment.

Blizzard Survival bags are a compromise, with both advantages and disadvantages. It is a compromise of size, weight, ease of use and effectiveness. They are by far the best survival bag on the market out performing any other survival bag. Their size and weight allow a person to carry more than one.

The fact that so many organisation; who have independently tested them for their needs. Suggest your comments are way off the mark.

When you’re on a side of an exposed mountain with a temperature just above freezing and buffeted by 60 mph winds and driving rain. Exactly the conditions the Blizzard Survival bag was designed for. And there is no shelter available; there is an argument that you don’t remove wet clothing from the casualty. Because, by removing the warm wet clothing you are removing some valuable warmth from the casualty. By placing a person in wet clothing into a survival bag and place them into a sleeping bag if you have one is thought to be safer than removing the casualty’s clothes.

There are many people that follow this view but as many that don’t agree and until some scientific testing is done it will be an argument that will go on and on.

I am pleased with your comments on Bothy Bags they are an excellent piece of kit and I highly recommend them.

I also agree with your comments about some form of insulation to sit on or lie on, this is true for the Blizzard Survival bag too. You definitely need insulation from the ground.

Sorry to have to disagree guys, but if you have pulseless patient, you need to perform CPR which includes chest compressions:

See the Journal of the American Medical Assocation Recommendations and other hypothermia links:

"Basic Life Support
If the victim is not breathing, rescue breathing should be initiated. Cardiopulmonary resuscitation (CPR) in the pulse-less patient should be begun immediately, although pulse and respirations may need to be checked for longer periods to detect minimal cardiopulmonary efforts. The traditional recommendation that pulse and respiration's be checked for 1 to 2 minutes before beginning CPR is probably excessive. A span of 30 to 45 seconds should be adequate to confirm pulselessness or profound bradycardia, for which CPR would be required." From:


Hypothermia Guidleines - CPR


"Check breathing and heartbeat. In cases of hypothermia you should check very closely for as long as two minutes.
Start CPR if necessary." From:

Paddlers Web Site

"Due to the limited amount of oxygen the body needs when hypothermic, I want to stress the importance of starting and continuing cardiopulmonary resuscitation (CPR) efforts with all victims of hypothermia," Tveita said. Doctors typically cease CPR efforts in a normothermic patient after 30 minutes. But CPR should continue on hypothermic patients until after they have returned to normal temperature, Tveita advised." From:

Medical News Today



Pete

Thanks for that Pete. Clearly your protocols say to give CPR and because this is US forum I will stop confusing matters.

Last night i was going to PM you but apparently your folder is full.

Interesting, I check my messages and only had 5 out 25 permitted. I deleted some more, so hopefully it will work.

Pete

Okay, so I have a question: Is there ever a place for a thermometer in a hypothermia kit?

I realize, of course, that when someone has hypothermia then knowing their exact temperature is not the priority. I was thinking more along the lines of hypothermia being difficult to spot in oneself if it's a gradual onset.

Not really Ann it would need to be of a low temperature reading type and the only effective way if taking a temperature from a hypothermic person is by inserting the thermometer at least 8 inches up the casualties bum.

A normal thermometer to see what the ambient air temp may be useful but it will not give any warning of likely hypothermia.

"Sorry to have to disagree guys, but if you have pulseless patient, you need to perform CPR which includes chest compressions..."

I won't go into detail about what I mean by "cold" but the specific issue is the ability to actually determine if the patient is in fact without a pulse. On very cold patients this can be difficult to determine and I was taught by two physicians in Alaska who are authorities on cold injuries/illenss not to perform chest compressions on a "frozen" patient. This is not the same as a pulseless patient.

Here's an interesting list of symptoms of Stage 1, 2 and 3 hypothermia: http://www.jonesactlaw.com/library/hypothermia-at-sea-a-major-risk-for-maritime-workers.cfm Yes, it's from a law firm... think they can be trusted?

The touching-thumb-to-little-finger is the simplest way to determine if someone is becoming hypothermic. If you're traveling with people you don't know reasonably well (or at all), and ask someone if they're too cold and they say they're all right, it's a reasonable request to ask them to prove it this way. It isn't like you're asking them to disrobe so you can stick an 8" needle/thermometer into their liver.

It seems to me that if you think someone is hypothermic, they probably are. You'll have to use your own judgment, not that of the victim.

Sue

This probably more than what you want to do, but for rescue teams transporting and treating hypothermic patients, it is an improvised low cost option. Ahead of time, you take an indoor/outdoor thermometer, which will read lower temperatures and generally has a probe on a 2-3 foot wire, coat the probe with silicon sealer which is allowed to cure thoroughly. When needed for use, the probe is coated with a lubricant and inserted into the rectum. The meter potion can be left outside of the hypothermic wrap for ongoing monitoring.

Pete

I agree with you njs. CPR is given to a normothermal person when they are not breathing normally. The present protocols do not take into account of pulse at all. So chest compressions are given when ever there is not a normal breath.

In a hypothermic person if they are breathing then we can assume their heart is beating so you can assist with breaths but not give chest compressions.

If there is no pulse and the heart has stopped beating then it is very doubtful if CPR would be any help anyway.

Thanks for that Pete, that is an interesting solution that I have not come across before.

I am sorry Sue but there listed treatment is very lacking and if you have a severely hypothermic person you will be putting them at further risk and could leave you open to prosecution if you followed their advise.

You may be covered by the good Samaritans laws in the states. A law company can not be substituted by doing a good First Aid course.

I wasn't interested much in their treatment, just the symptoms of the various stages of hypothermia.

Sue

In Norway (as I am sure, they do elsewhere) they are working a lot with how to treat hypothermia and not even the medical profession are clear on how to treat it since the treatmeant actually varies between patients. There is not one universal method of treating hypothermia.

An small excerpt from a statement made here: http://www.ntnu.no/gemini/2011-01/7.htm


"-So far, the results show that it is essential that the rescuers wrap the patients in a vapor barrier before they are being wrapped in blankets. The explanation is that since the cooled patients often are wet, you lose a great deal of body heat to the blankets and the environment through evaporation, rather than remain in the body."

I am not so sure about the advice to give sugar water to hypothermia victims. There is some pretty compelling reasons that practice might be counterproductive that I have seen elsewhere.

Like a lot of conventional wisdom type things, that advice may be based mostly on what people have been doing rather than what might work better.

I am more inclined to calories from fat than from sugar in such a case.

I have also seen some interesting speculations that drinking hot beverages might not be an especially good idea either.

On the bright side, most people who are in a position to actually eat or drink anything at all are probably not so far along in the hypothermia cycle that it makes all that much difference.

Can you please provide references?

Pete

ILBob

Your post goes against everything known about treating mild Hypothermia.

Hypothermia has a direct correlation with energy stores or lack of it, in the body. Shivering stops when the body runs out of the stores and you have nothing else to fuel the bodies response of trying to warm itself. A fire needs fuel.

If someone is hypothermic they need fuel in the form of simple (fast acting) and complexed (slow acting) carbs. The reason you give sugary food stuff is because it is fast acting fuel, it flash burns keeping the fire going until more complexed carbs (slow acting fuel) can be given to sustain the fire.

The first time I had mild hypothermia I was given an equal mix of sugar and milk powder mixed with water into a thick paste. This gave me enough energy to get of the hill.

The reason the milk powder was added is because it contain essential amino acids, vitamins and minerals, which the body needs to have replaced to take full advantage of the simple carbs.

If I can find them again I will.

I do hope you can locate those references. I think is it critical to our discussion that we can examine the science behind this alternative way of treating hypothermia. As with much of emergency medicine (CPR, tourniquets, use of IV fluids, etc.) there is a constant evolution of treatment modalities. Many types of medical treatment come into vogue and then fall out of favor, only to be “reinvented” in another form as our knowledge of physiology and the body’s reaction to various treatments is analyzed.

Pete

Resurrecting a thread, I suppose. Sorry about that.

Here where I live (Finland) winter is really cold, regularly dropping below -25°C (-15°F) during the day. There's luckily not strong winds, but still.

I don't actually carry any specific kit, unless you count general clothes and camping gear. So, a good sleeping bag, thermal mattress, wind barrier (space blanket, poncho, tent) and towel or sponge for drying yourself. There are, however, steps we take when crossing over ice or other high-risk endeavours.

I might consider carrying waterproof matches and solid or waterproof fuels (esbit, fire gel, candles) and easy-to-use heat packs (either ones you snap to activate, tear the foil (with numb enough hands, might be impossible) or those rechargeable one where you just flick the metal button inside (but these solidify in freezing temperatures and thus might not work when needed).

I wouldn't trust on anything requiring fine motor skills (even something as simple as butane lighters can be difficult to operate, let alone stoves you need to fill, pump, assemble or anything like that)

1. Stay dry. Remove excess clothes before an activity to avoid sweating. If you sweat, do not put clothes back on for a few minutes. You will cool down and the sweating will stop.
2. Always keep a set of dry clothes, with you or with your partner (see point 3).
3. When moving on ice, move in pairs and keep your dry set of clothes in your partner's bag. Keep a distance of about 5 metres between everybody. Stay out out areas of thin ice (steep embankments, river mouths, places with cat tails and whatnot poking through).
4. Check regularly yourself each other for signs (thumb to pinky finger is a good test). White, waxy skin surrounded by red ring is a sign of frostbite, but can also indicate hypothermia. Numb skin in another (especially toes, fingers, ears, nose and shins).


As treatment:
Stop any heat loss at once. Get the patient out of wet clothes, dry and inside a shelter (tent, space blanket, sleeping bag). Let them drink warm (not hot) liquids, the more carbohydrates in it the better).

Never check for temperature of any warm/hot liquid with your finger if you are hypothermic. Your fingers will be numb, and you can easily get 1st and 2nd degree burns without even knowing it. Same goes for metal cups and fire. The safest is to remember how long it took for water to heat up and count. (This goes for Thermos flasks too. Hot contents will burn you rather than warm you, so it might be a good idea to store warm liquids rather than hot ones).

I've seen people burn their mouths with beverages they thought we're only lukewarm, as well as turning red from soaking their hands in what turned out to be really hot water (as hot as you get from a tap) A few years back I got myself blisters on my toes when "slightly" warming them by the fire. I even remember thinking when I rested my feet to warm that the stones seem surprisingly cool for being so close to the fire. Not my smartest moment. (Definitely made the 15km hike back to civilisation the next day a more memorable experience).

A friend, who's runs a snow sledge safari once told me that the best treatment is to put the patient in a tent, on a mattress, and cover his torso only with blankets and give warm liquid to drink. That way the core temperature is supposed to heat up faster, reducing/removing the dip in core temperature as cold blood starts circulating again. Don't know if sure, haven't tested, and haven't seen it printed in any medical or survival book.

-jh

Don't forget to ask Beyonce to climb into the bivi sack, when you are trying to warm up. That's a very important step in the process. Ha! Ha!!

Alright, if Beyonce says "No", then you may need to ask one of your fellow team members to help warm you up. This is where you find out whether you really qualify for the "Miss Congeniality" award on your team. Good behavior does payoff!

On a more serious note ... I saw an excellent video about how to survive a fall into freezing water recently. Gosh, I wish I had made a note of that video and who did it. There was a leading hypothermia expert, and one of these TV survival guys. And they were both in an ice-cold pool, surrounded by ice. The expert had a number of really excellent tips about what to do, from the moment you hit the water. Has anyone else seen that video?

cheers,
other Pete

Here are links to a small kit that I favor:

The article
http://www.watertribe.com/Magazine/Y2002/M12/SteveIsaacWhenGodsPlay.aspx

The Kit
http://www.watertribe.com/Magazine/Y2002/M12/SteveIsaacMakeAHypothermiaKit.aspx

The modified em blanket
http://www.watertribe.com/Magazine/Y2002/M12/SteveIsaacModifySpaceBlanket.aspx

I've also found that a canteen cup type cooking cup and an esbit/sterno stove to heat coffee/tea/cocoa/broth for a hot beverage (boil kit) is a nice addition or consideration and some folks pointed out an MRE entree with heater would also allow for hot food/bev intake.

When hypothermia is a risk, I always take:

**a thermos of hot chocolate

*extra external warmth - extra wool sweater, socks, hat and AMK bivvy.

*extra internal warmth - something to boil water in, (GI canteen cup is my fave), something to sweeten it up (instant hot chocolate), and some high-fat simple carbs (chocolate and trail mix with chocolate are my favorites)

Our medical guy wrote a nice article on Hypothermia this month.

I found it interesting.

Hypothermia Prevention, Identification and Treatment Hypothermia Prevention, Identification and Treatment

Now THAT is a very well written down-to-earth article. I find nothing to add and nothing I disagree with. A highly recommended read

Agreed - informative and concise. I was impressed also with the companion articles.

Good article and some other good links there too.

There are lots of 'tricks' touted as to how to survive hypothermia. Getting dry, warmed externally, insulated and taking on fuel are all good. I'm not convinced that 1 approach is noticably better than another in reality

But priority number 1 is before you hit the water - PRACTICE! You need a simple foolproof plan that you have drilled if you have a hope of self-rescuing. Do not expect to be able to think it through or do anything the tiniest bit fiddly when the moment comes

Kit needs to be within reach, unpack quickly, not leave you scrabbling for kit etc

I'm with Bigreddog - practice. practice. practice. Good idea for all first aid procedures, especially the high adrenalin and life threatening ones. Try to get to the point where things are automatic habits, requiring less thought.

BTW - Bear's season premire was on la t week. He was in Norway, where he did set-up experiments instead of his usual adventuring. I found the hypothermia and flashflood scenarios particularly insightful.

The biggest problem with hypothermia is recognition and realizing that it is a potentially serious condition and not something that big strong men can just tough out. Putting on a jacket, eating or drinking something warm, perhaps taking the time to build a fire, are all relatively easy to do in the early stages of hypothermia, but as the victim cascades further down the slippery slope, treatment becomes much tricky. One needs to be on the lookout for hypo both in the group and in one's self.

Practice is good, but the real thing is still something much more stressful.

Glad to hear that BG has changed his format. Perhaps there is hope after all.

I added Mountain House "self-heating" "oven" [similar to MRE heaters I suspect] to my hypothermia kit, with the idea that pouring water and adding a salt tablet might be easier that starting a fire, deploying pots, etcetera.

Good addition Dweste. Having warmth in your kit that doesn't involve much though or deterity in a great idea. I wouldn't ditch the fire though.

Three problems I see with these and MRE heaters (same thing, different shape), based on my usage of the MRE heaters, is as follows:

1, they produce a LOT more heat than you want by your skin, but not enough to heat much of a volume. 2nd degree burns or freezing.
2, they produce lots and lots of hydrogen. KABLAMO! Or you drown in hydrogen.
3, they must be kept utterly dry.

The basical hot-hands type heat packs have #3, to a lesser degree #1, and not #2. Keeping in mind they are just paper and rust when they are done, they are also reasonably safe. MRE heaters... not so much.

Sorry I was not clear: my hypothermia kit includes several sealed hand-warmers and I have recently added the Mountain House "oven" only to heat food / meals / drink without needing flame.

Decided to add a second heatsheet bivy. Inherently more insulation and could stuff things between the two bivys for more insulation if stuff is available.

I checked the directions for the MRE heater that reposes in an odd corner of my gear closet. If I were hypothermic, following the instructions would be fairly challenging. There are several fire starting techniques that only involve large motor skills that would probably work better - and getting a fire going has worked fine for me in those times when we were dealing with hypothermia.

What these heaters provide is flameless cooking - a very good feature in a combat zone or in extremely dry conditions, but actually somewhat counter productive in the usual hypothermic situation.

The thing that amazes me about hypothermia is how quickly and thoroughly debilitating it can be. Considering fighting hypothermia in yourself, requires simplicity. Once prevention has failed, anything needing fine motor skills or much thinking may be far too difficult, wasting precious time. (Watch BG try to build a simple shelter and fire in his new Norway episode for a great example.)

That doesn't mean you shouldn't take things like MRE heaters. Just don't expect them to be useful until you're already warming up using the other methods mentioned in this thread. (i.e. get dry, into warm cothes, into a shelter, eat and drink high fat/sugary foods, etc.)

My kit is made of:
carnation breakfeast package
bivi bag by adventure medical kit ( but maybe will change to Blizzard one)
and a garbage bag
vargo wood stove with some wet fire
bothy bag
down booties
extra sox, buff, gloves
Experimenting right now with MRE heating pad.

http://download.journals.elsevierhealth.com/pdfs/journals/1080-6032/PIIS1080603201706771.pdf

http://download.journals.elsevierhealth.com/pdfs/journals/1080-6032/PIIS108060320970081X.pdf