Treating the Big Chill with out-of-date wilderness first aid procedure

amen. I am a former paramedic who took a wicked intense weeklong course directed by Dr Murray Hamlet. at Cat Island MA Dr Hamlet was director of the U.S. Army Research Institute of Environmental Medicine at the time. It went just a bit beyond the WFA curriculum. I don’t recall all the course as fun. Yes it was all valuable. It involved some insane water work in 39 degree water and jumping off heights.

I took the course as it jibed with my love of sea kayaking, my living on the New England coast and my career as a medic. My moniker is not something I grabbed out of the air.

In every day ambulance calls we handled some dozen hypothermia cases a year( mostly in the winter; people seemed to have to have a propensity to dump vehicles in tidal rivers). Because the risk of cardiac arrythmias we never wanted people to handle and jostle severely hypothermic victims if we were going to arrive within minutes. We had rewarming capabilities via heated IV solutions.

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My comment is, take everything you read on the internet with a grain and get proper first aid /cpr training from a qualified instructor if you desire the skill.

Thank you. Nearest I find that is semi-regularly offered is 10 hours away. An outdoor course is offered semi-nearby that I hear about every 3 years. If you have the name of a couple providers that would help.

I have said nothing and say nothing that disputes what you say in the above paragraph. (In case it may appear so, i apologize.)

That person does not need to disrobe to be an effective heat source, however.

Current expert opinion disputes your claim, as i have and do point out.

The bothy that I spoke off earlier in this thread was first recommended to me…

Good for you, but this does not add anything to the current debate.

Agreed, and i think Kevin C is misleading many readers with his article.

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My WFA trainers are currently operating via on-line (Zoom-based) courses, FYI.

Glad to know you are superior enough to be comfortable being left to die rather than let someone that doesn’t meet your standards help.

What is the current debate? Is it that you maintain that skin to skin contact is always contraindicated in treatment of hypothermia in the field?

This recent Medscape article indicates that it is in fact an option when other external heat sources are unavailable, as if often the case in an emergency scenario in the field.

And why do you think that a rescuer would necessarily have to be naked to serve as a heat source for a victim of hypothermia? It is necessary to remove wet clothing from the victim and if no dry clothing is available they might wind up naked but body heat radiates just fine through the clothing of rescuer in close proximity.

People that feel “superior” usually insult others to make themselves feel better, and quite often put the letters MD after their names.
As far as improperly trained individuals rendering aid. Incorrect or improper care quite often has a detremental effect on patient care and can and has caused further injury to the patient. Sometimes doing nothing is better then doing the wrong thing.

In the bush you use what you have. Carry a match safe on your life jacket. Fire is the best remedy. Second would be the sleeping bag. Hypothermia sneaks up on people. You have to watch people carefully. I have run into it only a few times. It was always worse than I thought.

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Fire is undoubtedly the best. But it can be time consuming or impossible to make in the field if everything is wet or snow covered and you have no axe or saw. On cold water paddling trips I do carry some dry tinder (dryer lint, Vaseline-coated cotton balls), a small telescoping fire starter tube, a couple of Bic lighters, a magnesium fire starter as a back-up. But unless I am on a multi-day expedition or downriver trip, the only saw I have on my person is a small folding saw in my PFD and no hatchet. I might be able to make a fire in those circumstances, but I am less than certain I could and I know it would take some time.

In the best case scenario multiple rescuers would be on deck and one could attend the victim while another made fire, and a third went for help. In one real life situation at which I was not present, but was described to me later by the victim, a very good whitewater kayaker and frequent paddling partner to me was kayaking a river in eastern Pennsylvania with his teenage son whom he had introduced to the sport at an early age. It was early spring, snow was on the ground, and there was nobody else on the river. My friend suffered a heart attack midway and they were miles from the put-in or take-out. They had no materials with which to construct a fire and the son had no choice but to find a spot for his dad as sheltered from the wind as possible and cover him with what was at hand, leaves, spray skirts, PFDs, etc. The son had to run along a rail trail that parallels that river for several miles to reach one of their vehicles and go for help. My friend was significantly hypothermic by the time EMTs arrived but fortunately did not develop any malignant dysrhythmias. My friend survived but sustained severe cardiac damage before advanced cardiac care was available. I don’t think he ever paddled again.

That was an example of doing what you can with what you have. It is no use to present algorithms full of treatment modalities that are unlikely to be available in the field in a real life scenario.

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You do what you do , with what is available. and hope it is enough.

I liked the article. And BTW We are not having a debate. This is a discussion

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Thanks.

I originally said that warming bodies with body heat was an “out-of-date and ineffective procedure for victims of hypothermia.” I must admit that i later changed it to the procedure being ineffective in cases of severe hypothermia, ie, the case in Kevin’s article.

A few of comments.

First, the hypothermia grading scales that use the terms “mild”, “moderate”, and “severe” hypothermia are of limited usefulness because there are multiple different schemes that define these levels of hypothermia in ways that are inconsistent. Grading scales that are based on core temperature are also of limited usefulness in the field because that often cannot be accurately measured.

Most professionals involved in the treatment of hypothermia now use the Swiss 5 tier rating scale for hypothermia which is based on easily observable criteria such as the presence or absence of a confused mental state, unconsciousness, the presence or absence of shivering, and the presence or absence of vital signs.

The scheme is as follows: HT-1: victim is conscious with clear mentation, is shivering, and has vital signs. HT-2: victim is conscious but has an impaired level of consciousness, is not shivering, and has vital signs. HT-3: victim is unconscious, is not shivering, but has vital signs. HT-4: victim is unconscious, is not shivering, and has no discernible vital signs. HT-5: basically dead. Patient is without vital signs and cannot be resucitated due to imcompressibility of the chest wall and (usually) severe hyperkalemia.

In the Swiss scheme the boundary between HT-1 and HT-2 usually occurs at a core temperature of around 90 degrees F or slightly less, but this can vary between different age groups and individuals. But if you look at the older grading systems, this degree of hypothermia is considered to be the boundary between “mild” and “moderate” in some, in the middle of the “moderate” range in others, and at the boundary between the “moderate” and “severe” range in others. So saying a person has “severe” hypothermia is somewhat ambiguous unless you define the criteria upon which that is based. The chart on page 15 of this pdf describing the Swiss rating system tells the story:

Second, I did not mention this before but will do so now. This is an extract from princeton.edu article you posted earlier:

“No matter how cold, patients can still internally rewarm themselves much more efficiently than any external rewarming.”

That is just plain wrong. It is so wrong that it suggests that the people who prepared that article have never actually seen or treated an individual with very severe hypothermia. If it were true, all that would have to be done in the hospital to treat those individuals would be to put them in a sleeping bag in a warm room and give them a bowl of warm broth, in other words passive rewarming. There would be no need for the entire panoply of active rewarming measures, one or more of which are often needed to rewarm a critically hypothermic individual.

I am talking about measures such as airway rewarming with warm, humidified oxygen-rich air delivered by nasal tube, mask, or even mechanical ventilator, external circulating warm air rewarming with a Bair Hugger or similar device, the administration of warmed intravenous fluids, body cavity irrigation of the pleural space or peritoneal cavity using warmed isotonic fluids delivered and exchanged through either thoracostomy tubes or peritoneal dialysis catheters, or active blood rewarming using a hemodialysis machine or ECMO machine. The fact is that one or more of these measures is very commonly necessary because a critically hypothermic individual has often had complete collapse of their thermoregulatory mechanism and are incapable of warming themselves with passive measures.

As for the pros and cons of placing two people in a sleeping bag, if you want to have a rational discussion this article out of NOLS is a reasonable place to start:

The author points out that while for maximal conductive heat transfer bare skin to bare skin contact is best, direct skin contact between victim and rescuer is quite limited so that conductive heat transfer does not amount to much. So bare skin on the part of the rescuer is not necessary and certainly warm, dry clothes should not be withheld from the victim, if available. The author also appears to consider quite dubious the assertion that direct skin warming is bad because it blunts the shivering response. I find that argument nonsensical because if that were so any skin warming measures such as warm compresses or hot water bottles would also be bad.

The value of having another person or persons in a confined space or shelter is that the non-hypothermic rescuers warm the air in it through convection of body heat. An enclosed shelter like a bothy also has the benefit that the air inside of it fairly rapidly becomes warmed and humidifed which reduces the heat loss that would otherwise occur as a result of respiration, which might not be the case if the victim were in a bivy bag.

Again, you use what you have. If you only have a one person bivy sack or sleeping bag that two people can’t possibly get into you are obviously not going to do that. Obviously, you are not going to delay evacuation if available so as to warm someone up in a bivy or bag. That seems to be a completely made-up argument. If you have a two person bothy shelter that is what you are going to use, unless the victim is too unstable to be safely kept in a semi-upright sitting position. Even then the bothy can be used as a small tent to cover a victim lying in a fetal position if the roof is held up with an appropriate length stick or some external cordage.

Putting two people in a bag or bivy may not be the most effective way of providing and external source of warming for a hypothermic individual, but it might be the best available under the circumstances.

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and…even tho the title of the article pointed at the Big Chill. The article was also about wearing a PFD and about time of year and cloths chosen. And about making the correct choices. Lite little reminder article.

Probably the best way to deal with hypothermia, is to dress for immersion. That means a wet suit or dry suit. Prevention is better than treatment.

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