{"id":6701,"date":"2022-09-19T16:24:48","date_gmt":"2022-09-19T16:24:48","guid":{"rendered":"https:\/\/asnes-academy.com\/uncategorized\/handling-hypothermia\/"},"modified":"2022-12-21T22:11:53","modified_gmt":"2022-12-21T22:11:53","slug":"handling-hypothermia","status":"publish","type":"post","link":"https:\/\/asnes-academy.com\/en\/mountain-and-safety\/handling-hypothermia\/","title":{"rendered":"Handling hypothermia"},"content":{"rendered":"\n
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Dealing with hypothermia<\/p>\n\n\n\n

Hypothermia occurs when the body is exposed to cold, or cannot maintain the production of heat in a cold environment.\n\nIn accidents that cause unconsciousness, the body\u2019s core temperature can plummet. Hypothermia also occurs among avalanche victims \u2013 albeit suffocation and trauma are greater threats there. Moving through the mountains without adequate clothing and planning can have serious consequences. Every year, many have to be rescued by volunteers and rescue teams. There can be many reasons why, but none are adequately protected from the environment.\n\nHere we review advice from the Norsk Fjellmedisinsk Selskap (Norwegian Mountain Medicine Society), the rescue services, doctors, and add some of our own, to prevent and treat hypothermia.<\/p>\n<\/div><\/section>\n<\/div>\n\n\n\n

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Hypothermia (facts)<\/h2>\n\n\n\n

A person is held to be hypothermic when the body’s core temperature is lower than 35 \u00b0C<\/a>.<\/p>\n\n\n\n

Mild hypothermia (core temp. 35\u201333\u00b0 C)<\/td>Shivering; increasing lethargy.<\/td><\/tr>
Moderate hypothermia (core temp. 32\u201329\u00b0 C)<\/td>Shivering decreases; consciousness threatened; possible hallucinations.<\/td><\/tr>
Serious hypothermia (core temperature under 28\u00b0 C)<\/td>Trembling ceases; unconsciousness; slow and weak breathing; may be mistaken for dead. Heart rhythm changes; possible cardiac arrest.<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

Source: Store medisinske leksion<\/a><\/p>\n<\/div>\n\n\n\n

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Treating a hypothermic patient<\/h2>\n\n\n\n

Responding to someone suffering hypothermia is without doubt challenging. Knowledge of the most important principles is potentially lifesaving. This is just as relevant for us moving through the winter mountains for own pleasure as it is for professional rescue services and guides.\n\nThe basic method\u2019s the same, whether for an emergency response team treating a sufferer with advanced equipment or for the rest of us, treating a friend. Some familiarity with these relatively simple measures can make a big difference. It\u2019s important to be aware that patients with hypothermia must be treated very carefully, however. If one has no way of taking the sufferer\u2019s temperature, then it\u2019s good practice to assume that the patient is cold or in danger of becoming so.<\/p>\n\n\n\n

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Norsk Fjellmedisinsk Selskap (NFS)<\/a><\/p>\n\n\n\n

This article explains practical measures for treating hypothermic people who are not in cardiac arrest \u2013 whose blood is circulating. The same procedures function to prevent injured and sick patients in the mountains from freezing.\n\nIn situations where sufferers are in cardiac arrest or suffering severe hypothermia, more advanced and complicated responses are required.<\/p>\n<\/div>\n<\/div><\/section>\n<\/div><\/div>\n\n\n\n

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Checklist for victims of hypothermia<\/strong><\/h2>\n\n\n\n
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<\/a><\/path><\/svg><\/span>Ring etter hjelp! Vit hvor du er og si fra hvor du skal. Last ned 113-appen p\u00e5 telefonen din, s\u00e5 f\u00e5r n\u00f8dsentralene din n\u00f8yaktige posisjon opp p\u00e5 skjermen.<\/span><\/div>\n\n\n\n
<\/a><\/path><\/svg><\/span>Mest mulig sk\u00e5nsom h\u00e5ndtering.<\/span><\/div>\n\n\n\n
<\/a><\/path><\/svg><\/span>Hindre de fire formene for varmetap. \u2013 Bruk \u00abBanak-modellen\u00bb. F\u00e5 pasienten opp fra bakken, isoler, kle p\u00e5, f\u00e5 inn i ly, husk lue og pakk inn i plast\/dampsperre<\/span><\/div>\n<\/div><\/div>\n\n\n\n

Prevention<\/h3>\n\n\n\n

Conduction heat loss the ground can be prevented by insulation with sleeping mats, down jackets, sleeping bags, spruce branches or anything else you may have to hand. Get the patient off the ground!<\/p>\n\n\n\n

Convection heat loss can be prevented by protection from wind and weather. Shell jacket, tarp, tent fly-sheet or a bivvy bag function excellently.<\/p>\n\n\n\n

Radiation heat loss is prevented by covering exposed skin, especially the head. Whatever you have to serve as a hat will do!<\/p>\n\n\n\n

Evaporation heat loss can be prevented with a tight vapour barrier around the patient. If nothing else, a plastic sheet will work.<\/p>\n\n\n\n

Source: Norsk Fjellmedisinsk Selskap<\/a><\/p>\n<\/div><\/section>\n<\/div><\/div>\n\n\n\n

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The four principal causes of heat-loss \u2026<\/h2>\n\n\n\n

… and how to prevent them.<\/p>\n\n\n\n

Managing heat-loss is, of course, entirely central to the treatment of people whose exposure threatens their well-being. The aim is to manage the patient so that they don\u2019t become colder and, of course, to increase the body temperature. To make these measure most effective, some understanding of how body heat is lost to the surroundings is helpful. So it\u2019s worth going into some detail on the most important causes of heat loss and the most effective measures linked to the various underlying causes. Meet conduction<\/em>, convection<\/em>, radiation<\/em> and evaporation.<\/em><\/p>\n\n\n\n

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Source: Head JF, Elliott RL. \u00abInfrared imaging; making progress in fulfilling its promise\u00bb. & Ring EF, Ammer K. \u00abInfrared thermal imaging in medicine\u00bb.<\/p>\n\n\n\n

Exhaustion \u2013 physical and mental<\/h2>\n\n\n\n

Prevention begins with taking care of yourself<\/strong>. Many accidents, mishaps and injuries (hypothermia among them) occur because people make very simple mistakes with pretty serious consequences.\n\nIf you don\u2019t take in enough sustenance, dress inadequately, or take ill-thought-out \u201cshortcuts,\u201d the results can be pretty bad<\/strong>. One of the most important preventative measure you can take is simply taking care of yourself.<\/p>\n\n\n\n

Get enough nutrition, take in enough energy, drink enough water, get enough rest and be mentally present. If you\u2019re exhausted and run out of energy, your brain doesn\u2019t function optimally either. It can lead to poor choices, or simply sloppiness.\n\nLearn to know your body. Pay attention to what it tells you. If you feel it\u2019s time to eat, eat some simple snacks or nuts to be on the safe side. If you notice a slight headache, have something to drink. Act on your body\u2019s feedback before things go wrong. Change into dry clothes as soon as possible.\n\nRunning out of energy in the winter mountains can have fatal consequences.<\/p>\n<\/div><\/section>\n\n\n\n

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Conduction<\/h2>\n<\/div>\n\n\n\n
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Explantion<\/h3>\n\n\n\n

Heat-loss through conduction occurs when we lose heat through contact with something colder than we are \u2013 the cold, snow-covered ground, for example. And the greater the contact, the more, and faster, we lose our heat.\n\nWater and metal conduct heat quickly. Materials such as foam rubber, down and other insulation, the kids of things we commonly take out on a trip, conduct heat poorly. They\u2019re helpful, then, in preventing or slowing down freezing.<\/p>\n\n\n\n

Measures<\/h3>\n\n\n\n

To stop surfaces \u201cstealing\u201d our heat, insulate patients against them with things such as a sleeping mat, a down jacket, or any other insulating materials you have at hand.<\/p>\n<\/div>\n<\/div><\/section>\n<\/div><\/div>\n\n\n\n

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\nCovering up during a rest break and taking a rest on the \u201carctic bedding\u201d packed on the pulk is better than sitting down directly on the cold snow and giving off heat to the ground. Sitting or sleeping mats are also a good idea.\nPhoto: Christian Iversen Styve<\/figcaption><\/figure>\n<\/div><\/section>\n\n\n\n
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Convection<\/h2>\n<\/div>\n\n\n\n
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\nExplanation<\/h3>\n\n\n\n

Heat loss from convection occurs through the transfer of heat from one place to another through the movement of currents of air or water. This is typically wind or water. Rain will do it if you aren\u2019t actually submerged. When the body is exposed to wind and water in motion, the body\u2019s heat is carried off as cooler wind or water is replaced at the contact surface. Then the body\u2019s temperature can drop rapidly.<\/p>\n\n\n\n

Measures<\/h3>\n\n\n\n

Heat-loss of this kind is best prevented by isolating the body from the wind or water causing it. In practice, this means seeking shelter or getting a soaked person somewhere dry. It is essential to isolate, cover and protect the afflicted person using something such as a tent, a bivvy bag or extra clothing.<\/p>\n<\/div>\n<\/div><\/section>\n<\/div><\/div>\n\n\n\n

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\nIf you experience bad weather, severe wind or a whiteout, then seriously consider shelter in a tent or bivouac bag to prevent yourself from freezing. If someone\u2019s injured and frozen, it\u2019s vital to get them some protection.\nPhoto: Christian Iversen Styve<\/figcaption><\/figure>\n<\/div><\/section>\n\n\n\n
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Radiation<\/h2>\n<\/div>\n\n\n\n
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Explanation<\/h3>\n\n\n\n

Heat-loss through radiation is a consequence of the laws of physics \u2013 the universe likes equibilrium, basically. Heat radiates from something hot (your body, say) to something cold (like the air). As long as the body\u2019s surroundings are colder than your skin, you\u2019ll be heating it to some degree or other. Eventually you run out of heat. In freezing conditions, that can be a survival issue.<\/p>\n\n\n\n

Measures<\/h3><\/p>\n\n\n\n

Dealing with radiated heat-loss begins with dressing appropriately before you head out into the wilds. Use clothing that reflects and retains heat \u2013 a shell and an insulation layer \u2013 to prevent exposure, limiting heat loss to your surroundings.\n\nThe greatest heat loss from radiation occurs from the head. Wear a hat. And cover the head of those who are suffering from exposure to cold.<\/p>\n<\/div>\n<\/div><\/section>\n<\/div><\/div>\n\n\n\n

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When it’s really cold outside, a good and warm hat is worth its weight in gold. A hat like this can also be essential for treating severely chilled patients \u2013 a great part of the body heat lost through radiation is lost at the head.\nPhoto: \u00c5ste Innleggen<\/figcaption><\/figure>\n<\/div><\/section>\n\n\n\n
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Evaporation<\/h2>\n<\/div>\n\n\n\n
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Explanation<\/h3>\n\n\n\n

Why do we sweat? To cool down.<\/p>\n

It requires energy to convert water to vapour \u2013 which is what happens when evaporation occurs. If we get wet in a cold environment (with sweat from climbing hills on skis, or drenching by sleet, say) the consequences can be serious. Water conducts heat 25 times faster than air. If your clothes get wet, they won\u2019t insulate you \u2013 and heat loss through evaporation will increase enormously.<\/p>\n

The body will work overtime to heat the cooling skin. This can lead to hypothermia.<\/p><\/p>\n\n\n\n

Measures<\/h3>\n\n\n\n

Dress to stay dry. Ventilate (open zips; take off your neck covering); use layers; change into dry clothes if they get wet. In situtations where hypothermia has begun, a vapour barrier is useful: make sure insulating layers are dry and wrap the sufferer in bubble wrap, plastic refuse, rescue foil or cling film!<\/p>\n<\/div>\n<\/div><\/section>\n<\/div><\/div>\n\n\n\n

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A couple of rubbish bags can be good to take with you on a trip. They\u2019re useful for so many things. Emergency tarp, rubbish storage, life-saving vapour barrier…\nPhoto: Crister N\u00e6ss\/ \u00c5snes<\/p>\n<\/div>\n\n\n\n

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Cling film\u2019s another clever thing to take in your kit. A long length can can be twisted to become a \u201crope\u201d or a splint for bones. It can serve as a \u201cbandage\u201d in case of bleeding \u2013 and an extremely effective vapour barrier for people suffering from exposure to cold!\nPhoto: Crister N\u00e6ss\/\u00c5snes<\/p>\n<\/div>\n<\/div><\/section>\n<\/div><\/section>\n<\/div><\/div>\n\n\n\n

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“But all this is obvious…”<\/h2>\n\n\n\n

Yes. Much of this advice seems obvious to the point of being banal. We know to address appropriately when we go to the shops in winter, right? Dressing appropriately for a trip to the wilderness isn\u2019t exactly the apogee of mountaincraft. OK: but hypothermia isn\u2019t \u201cfeeling cold\u201d (and, by the way, we\u2019re not likely to break the ice on a frozen river or become hypoglycaemic on the way to the supermarket).\n\nCaring for people suffering from hypothermia, our \u201ccommon knowledge\u201d must coincide with more specialised knowledge of human physiology and the laws of physics if it is to be useful. \u00c5snes Academy Expert Panel<\/p>\n\n\n\n

<\/p>\n\n\n\n

In practice, heat loss in a patient is alleviated by counteracting the causes of heat loss simultaneously, by wrapping patients properly. Emergency rescue teams in Norway uses a model called the Banak model<\/a>.<\/p>\n<\/div><\/section>\n\n\n\n

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“But all this is obvious…”<\/h2>\n\n\n\n

Yes. Much of this advice seems obvious to the point of being banal. We know to address appropriately when we go to the shops in winter, right? Dressing appropriately for a trip to the wilderness isn\u2019t exactly the apogee of mountaincraft. OK: but hypothermia isn\u2019t \u201cfeeling cold\u201d (and, by the way, we\u2019re not likely to break the ice on a frozen river or become hypoglycaemic on the way to the supermarket).\n\nCaring for people suffering from hypothermia, our \u201ccommon knowledge\u201d must coincide with more specialised knowledge of human physiology and the laws of physics if it is to be useful. \u00c5snes Academy Expert Panel\n\nIn practice, heat loss in a patient is alleviated by counteracting the causes of heat loss simultaneously, by wrapping patients properly. Emergency rescue teams in Norway uses a model called the Banak model.\n\n.<\/p>\n\n\n\n

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Many layers of insulation, wrapping and heat-loss reduction. The “Banak modellen” effectively counteracts all forms of heat-loss.\nPhoto: Hovedredningssentralen<\/a><\/figcaption><\/figure>\n\n\n\n
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Photo: Norsk Folkehjelp\/Hovedredningssentralen<\/a><\/figcaption><\/figure>\n\n\n\n

Gentle handling\n<\/strong><\/h2>\n\n\n\n

When the core temperature drops, major changes in the body\u2019s physiological processes occur. The circulatory and respiratory systems are particularly vulnerable. Several cases have been recorded where patients who are comparatively alert when rescue services arrive lose consciousness and go into cardiac arrest when they\u2019re pulled into a boat or a helicopter. While the exact mechanisms for this haven\u2019t been conclusively identified, it\u2019s probably something to with the balance of salts and waste substances in the body\u2019s extremities suddenly returning to the heart.\n\nThis makes the management of hypothermic patients complicated. Being as gentle as possible in a situation where a patient must be immediately evacuated from a mountain or frozen water presents problems. The only solution is to find a sensible middle ground: keep the patient lying as horizontal as possible, for example; this improves the prognosis and reduces the risk of cardiac arrest.<\/p>\n<\/div><\/section>\n\n\n\n

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Sources<\/h2>\n\n\n\n

\u00abFaglig retningslinje for h\u00e5ndtering av aksidentell hypotermi\u00bb \u2013 Nasjonal kompetansetjeneste for traumatologi<\/a><\/p>\n\n\n\n

\u00abHypothermia\u00bb \u2013 Deranged Physiology (A free online resource for Intensive Care Medicine)<\/a><\/p>\n\n\n\n

Aksidentell hypotermi \u2013 en utfordring for redningstjenesten \u2013 Hovedredningssentralen<\/a><\/p>\n\n\n\n

Ressurser: Hypotermi & \u00abH\u00e5ndtering av Hypotermi\u00bb \u2013 Norsk Fjellmedisinsk Selskap<\/a><\/p>\n\n\n\n

\u00abHypotermi\u00bb \u2013 Store Medisinske Leksikon<\/a><\/p>\n\n\n\n

Nasjonal kompetansetjeneste for traumatologi (NKT-Traume)<\/a><\/p>\n\n\n\n

R\u00f8de Kors v\/ Voss R\u00f8de Kors Hjelpekorps<\/a><\/p>\n\n\n\n

Norske Alpine Redningsgrupper<\/a><\/p>\n\n\n\n

Hordaland R\u00f8de Kors \u2013 Skredgruppa<\/a><\/p>\n\n\n\n

Norsk Folkehjelp<\/a><\/p>\n\n\n\n

Head JF, Elliott RL. Infrared imaging; making progress in fulfilling its promise. IEEE Eng Med Biol Mag 2007;21:80-85.<\/p>\n\n\n\n

Ring EF, Ammer K. Infrared thermal imaging in medicine.  Physiol Meas. 2012;33:R33-46.<\/p>\n<\/div><\/section>\n<\/div><\/div>\n\n\n\n

<\/p>\n","protected":false},"excerpt":{"rendered":"

Do you know what to do when you\u2019re faced with someone dangerously cold? Command of the basic facts can be lifesaving \u2013 and this is just as relevant for us those of us who hit the mountains for the joy of it as it is for guide and members of the rescue services.<\/p>\n","protected":false},"author":4,"featured_media":4495,"comment_status":"open","ping_status":"open","sticky":false,"template":"templates\/tpl-nopadding.php","format":"standard","meta":{"_acf_changed":false,"_uag_custom_page_level_css":"","footnotes":""},"categories":[44],"tags":[],"class_list":["post-6701","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-mountain-and-safety"],"acf":[],"yoast_head":"\nHandling hypothermia - \u00c5snes Academy<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/asnes-academy.com\/en\/mountain-and-safety\/handling-hypothermia\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Handling hypothermia - \u00c5snes Academy\" \/>\n<meta property=\"og:description\" content=\"Do you know what to do when you\u2019re faced with someone dangerously cold? 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