OK, I’ll have to admit, you’ve got me here, suspended in a “bad advice” belief myself. Since most medical help websites still emphasize that “gradual” rewarming is key, and, when in emergency scenarios, improvisation is often what one is forced to work with, other than blankets and perhaps first-aid kit heat packs, why would this application of heat transference be “out -of-date and ineffective”? I mean, other than the possibility the all ready disoriented sufferer might suddenly bolt upright and run in inflamed fear for their lives, thinking they’d been laid upon a cold slab in Victor von Frankenstein the VII’s laboratory, next to Igor’s recently harvested cadaverous remnants of Phyllis Diller’s Uncle Pickle?
I’m not very cold resistant but my wife is great when some close contact warming is needed. I’m not talking about that kind of warming!
I fail to see why two bodies in a closed space wouldn’t be very effective at warming a hypothermic person.
Why is it outdated? The article was clear it was an interim measure taken while waiting for the ambulance to arrive.
I am quite sure that Kevin did not have the equipment or skills to do extracorporeal assisted rewarming or even administering warm IV fluids or using a electrically or warm air blankets as found in ER’s/
If you are going to complain please also offer a solution
I try to always have fire making options whenever I’m out in the cold no matter what the activity. Other items depend on specifics and what I may think to grab, right down to the ability to put together a shelter. Even more important to be prepared when you are always alone out there.
In the case of mild hypothermia – the patient is still shivering – yes, use hot drinks or another body to help warm the patient.
In the case of moderate to severe hypothermia – shivering has already stopped – wrapping the patient in a very insulated burrito with warm water bottles in the groin and armpits is best
See, for example
The reason – i remember from my WFA courses – is that there is only superficial warming (skin on skin) possible with another warm body in close contact. That is fine in mild – non life threatening – hypothermia.
and that was addressed in the article… They would have made a fire but from the get go they would have had to leave the victims and gather fire making material and start a fire . Meanwhile the ambulance was on the way. This was not a wilderness situation.
The first priority is to get the wet clothing off. And to get the victims into something dry. Then comes the application of heat. Not enough time to start the fire making thing when you have already have doused the fire in preparation for departure.
The decision making tree has many limbs and the situations were not all cut and dried. In a wilderness situation you may have to do something different. Get them out of the wet stuff and while one person huddles the other( on a surface like a tarp rather than direct contact with the ground) makes a fire and actually makes a shelter around and above the fire to contain heat. ( this is where the beauty of a winter tent comes in handy… Internal stove, no flammable floor and treated canvas) Meanwhile the PLB should have been activated.
That said I am wondering about the environs in Kevin’s article. In a campground implies a vehicle and a vehicle has heat… unless a snowmachine or ATV which I don’t think he uses
In any case alcohol is a no no and fluids sometimes best not be given to those who cannot protect their airway.
No you are absolutely wrong. The other person or persons act as convective heat generators and their body heat is trapped within the bivy or sleeping bag. It is not just superficial skin on skin warming which is conductive heat transfer.
Individuals who are severely hypothermic are so vasoconstricted that they often cannot generate much external body heat so placing them alone in a bivy may not be sufficient.
The incident described in the article occurred as a result of cold water immersion resulting from a paddling mishap. I have done a fair amount of whitewater paddling during the winter and early spring on very cold water where the possibility of hypothermia is very real.
A bivy sack is a reasonable option and can pack very small. But unless one also has a pad or insulator with a high R value, placing the victim in a bivy sack on cold, wet ground or snow will result in a lot of heat loss to the ground.
Of course, some basic fire making equipment should be carried. But it takes time to make a fire, especially when everything is wet. A kayaker on a day trip is unlikely to have a sleeping bag in their boat and probably not a pad that will function as an effective thermal barrier. Hot drinks and hot water bottles are also not likely to be at hand, at least not immediately.
If someone is severely hypothermic an immediate shelter and immediate treatment are required. As Kim said, getting the wet stuff off is critical and the first order of business to stop further conductive heat loss. Then some type of rewarming must begin.
On cold water paddling ventures I have taken to carrying a small 2 person bothy bag made by Integral Designs. This packs down to the size of half a loaf of bread and is quite light. It is a simple roughly conical fabric shelter that two people can huddle together under in a sitting position and has two flaps that can be tucked under their rear ends to avoid direct contact with the ground. If necessary the rescuer can support the victim with their arms. These can be deployed immediately using either the heads of the individuals, a hiking pole, or a stick to hold the fabric up. They are quite claustrophobic but very effective in trapping convective body heat.
These have been specifically recommended to my by swiftwater rescue professionals and instructors at NOLS.
The Integral Designs bothy may have been discontinued, but new, old stock may be available and there are other makers of emergency bothy shelters. They also come in various sizes for 2 people, 4 people, 6 people or more.
Here is a video that describes and demonstrates the Integral Designs 2 person bothy:
Here is a shorter video demonstrating the Integral Designs Bothy 2. It is in French but if you do not parler you can still see how it is used and it includes some good interior views in use:
These things do not breathe and have limited ventilation so if you spend a long time fully enclosed in them you may start to sweat. If someone is so far gone as to not be able to be supported semi-upright they are less useful. Their advantage is that they can be deployed very quickly and do not require the victim to lie on the cold ground. Your butt contacts the ground with a thin layer of fabric interposed, but two paddlers are going to have two PFDs (hopefully) which can be placed between the fabric and the earth and are quite good thermal insulators.
If you get your first aid information on a forum, please don’t give me aid.
Please do sign up for a proper course, I’m an Outdoor Emergency Care Instructor and would be happy to assist in getting people to proper training.
Body-to-body rewarming of a shivering patient with a
warm person in a sleeping bag blunts the increase in shivering thermogenesis,
resulting in rewarming rates no greater
than shivering alone. Body-to-body rewarming may
make the cold patient more comfortable due to decreased
shivering, but at the cost of delaying evacuation. Recommendation. Body-to-body rewarming can be used
in mild hypothermia to increase patient thermal comfort if
enough personnel are available and it does not delay evacuation to definitive care
My friend, I have treated patients in hospital with severe hypothermia and have an MD degree.
I have had swiftwater rescue training and training in emergency medical treatment of injuries and hypothermia in the field from some of the foremost recognized experts in the field that is relatively recent.
If you actually read the reference you cited you will know that many of the treatment modalities listed for treatment of severe hypothermia are simply not going to be immediately available in the field. Such as multiple sleeping bags, wool blankets, ensolite pads to create a minimum of 4" of insulation all around the patient and between the patient and the ground, chemical heat packs, or other external heat sources mentioned including hot water bottles, warm rocks, warm compresses, or towels. And immediate evacuation is often simply not an option. And nobody is going to do “rescue breathing” on a severely hypothermic individual who is still breathing.
If a hypothermia victim is still shivering they can usually generate enough heat to rewarm themselves but insulation from the cold and wet is still essential. Most victims of severe hypothermia have stopped shivering and those individuals often do not have the capability to rewarm on their own. Obviously the victim should not be left naked if dry clothing is available but often the only external heat source immediately available is another person in close proximity in a confined space. That person does not need to disrobe to be an effective heat source, however.
The bothy that I spoke off earlier in this thread was first recommended to me by Justin Padgett, wilderness EMT and executive director of Landmark Learning who teaches wilderness first aid and swiftwater rescue at Landmark Learning: https://www.landmarklearning.org/our-faculty/
Padgett sits on the national curriculum board of the ACA for swiftwater rescue.