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