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If you were that person, suddenly finding yourself on the ground, would you survive the night? I doubt I would. Local people helped to keep her warm as best they could. They brought blankets, a pillow, and hot water bottles. It all helped. Three hours later a police car came past, the officers asked a few questions and then got the patient to sit up, then into a car, and away she went. It got me thinking how well first aiders are equipped to deal with hypothermia as iIt’s not part of the syllabus for First Aid at Work.

When we consider people becoming hypothermic (core body temperature 35°C and below) there are so many variables. Here’s just a few to consider.

 

  • Age of patient.
  • Body mass of patient.
  • Underlying medical conditions.
  • Mobility and injuries sustained.
  • The surface the patient is lying on/in.
  • Weather conditions.
  • Ambient air temperature.
  • Duration of exposure

 

This list is not exhaustive. You’ll appreciate that with so many variables I will look at the fundamental principles.

This blog will therefore look at why keeping warm is so important. We will learn about the processes by which people lose heat and how to combat these.

 

Why keeping warm is so important.

 

We are warm blooded creatures. Put it another way, if our blood becomes cold, then we will die.

 

Losing body heat can be relatively quick or it can be a slow drawn out process. Being in a cold sea, river or lake, will lead to rapid heat loss, whereas being sat in a chair in a cold room for a long time, not eating much, could take over 24 hours, but it will happen.

 

  • If our brain becomes cold, it will not work as well, therefore the hypothermic patient lacks good judgement, lacks coordination of movement, speech becomes slurred and they display increasing levels of confusion. Left unchecked, they will become unconscious and eventually die.
  • If our muscles become cold, they will not work as well. They will stiffen, less able to stretch and contract, and therefore the hypothermic patient becomes more clumsy, prone to falling. Worse still, the heart, being muscle, will not pump as well, and the electrical signals that control the heartbeat, can fail. At that point you have a patient in cardiac arrest.
  • If our blood becomes cold it will not clot as quickly. Blood clotting is a chemical process, and chemical processes accelerate with heat, and slow down with cold. If we have an injured person on the ground, then by keeping them warm we may reduce blood loss, whether it be from internal or external bleeding. That’s why, when you read the first aid manuals, and they talk of patients going into shock, and they instruct you to keep the patient warm, it’s not just because of comfort, it’s to give them the best chance of survival.

 

How do we gain heat and keep our blood warm?

Yes, we can bask in the sun or we can turn the central heating up in our home, but ultimately, it’s the furnace inside your core that keeps you warm. When we eat and drink, the digestion process creates heat and this warms our blood. Your body literally converts some of the calories in your food into heat. If you don’t eat enough then you will be more prone to becoming hypothermic.

 

 

Advice Tip.

Eat well, but especially if you are going to be involved in outdoor activities, and take snacks with you. Keeping fueled up helps you fight off hypothermia.

 

 

 

Real life scenario.

As an ambulance crew we were called to an elderly patient, who was confused, but still sitting in a chair. We carried out our patient assessments and discovered she was severely hypothermic. This had been a slow process, the house was a bit cold, she hadn’t been eating much, and had just been sitting in the chair. Those elements combined over time made her hypothermic. She had to be taken to hospital for specialised, slow-rewarming treatment.

 

 

 

Please keep an eye on your vulnerable family members and neighbours; hypothermia can be an insidious event.

 

There are four processes by which heat is lost.

 

 

1. Conduction. If we are in contact with a cold surface, heat will transfer from our body to that surface. 

 

Treatment advice.

Insulate the patient from a cold surface. Foam mats work well, but so does cardboard, even plastic sheeting.

 

 

 

 

Real life scenario.

As a customer I was asked to help someone who had collapsed at a table. I remember at the time that the patient’s skin was hot and clammy. Feeling unwell the patient was laid on the ground. She stayed there for an hour before we could get her up onto a chair. An hour after that, the ambulance arrived. The crew measured the patient’s temperature which had now dropped to about 36°C. The moral of the story is that hypothermia can set in quickly. Lesson learned, I should have got something under the patient for that hour that she was on the ground.

 

As first aiders, insulating someone from the ground may be as easy as the patient getting up themselves and sitting on a chair. If they are injured then you’ll have to take the extent of their injuries into consideration and make a judgement call. You can always call back on 999 and update them of your deteriorating situation and the challenges you have. At the end of this blog is a link to a video which shows how you could insulate a person who can’t get themselves up, but is not badly injured.

 

 

  1. Evaporation. If a patient is in wet clothing, or their skin is wet, then they will warm up that water until it evaporates. This is taking heat away from them. 

  

Treatment Advice.

Where possible, get the person out of wet clothing and dry the skin. In extreme circumstances you may have to cut clothing off.

 

 

 

 

 

Real life scenario.

As a paramedic I once went to a diabetic patient who was found on the living room floor. She was very confused. Even after her sugar levels had been corrected, she remained confused. The reason? Yes, she was hypothermic. Her hypoglycaemia had caused her to sweat heavily. In her weakened state she fell to the floor, so she was now losing heat by conduction and by evaporation. Although it was summer, and although she was indoors, she had become hypothermic. We had to get her off the floor, get her out of those wet clothes, dry the skin, get her into warm dry clothing, and then transport to hospital for specialised slow re-warming therapy.

 

 This would be a challenging situation, one where the first aider could easily feel overwhelmed, but one where we do need to get that person out of wet clothing. An exception may be when the person is in a public place and help, the privacy of an ambulance, is just a few minutes away.

 

 

  1. Radiation

We radiate heat to our surroundings. We can slow this process down by insulating ourselves from the environment.

  

Treatment Advice.

Where possible, get extra layers on and around the person. An ideal garment would be a high quality sleeping bag, down jacket, fleece, wool, blankets, multi-layered clothing that will trap air. 

Real life scenario.

As a tourist in the Andes, I was up at 6000m. Although the air temperature was about -15°C, I was wearing multiple layers which included a down jacket, and a windproof jacket, and I was warm. Even in the harshest of environments good quality clothing protects us from radiating heat.

 

 

 

 

  1. Convection

The dreaded wind-chill. Wind (and water) strip heat away from us. In fact water strips heat away from us much faster than the wind. We need shelter.

 

 

 

Treatment Advice.

Get the patient out of the wind and wet, and into a shelter. If they can walk, that could be a building, a vehicle or some natural cover. If they can't be moved then a group shelter (a tent without poles), a bivvy bag or survival bag could be a life-saver.

 

Real life scenario.

A kayaker sustained a back injury and came out of their boat. Lying in the water, they did not want to move. Some of the group stayed at the scene and offered support, whilst others went to get help. Despite wearing appropriate gear, a dry-suit, fleece undergarment and base layer it got to a point where the immense cold was unbearable, and so was helped out of the water before rescue services arrived.

  

 

Let’s put that all together now. As I mentioned at the beginning, there are so many different scenarios. For some, all four of these processes provide a threat, for others, there may only be one or two. Below there is a link to a video that shows how you might deal with a patient lying on cold ground outside, waiting for an ambulance. To get the plastic sheet under the patient, it was folded in half, and then the top half folded back on itself, creating a bit of a concertina effect. With 15° body tilt, the sheet can be fed up to the patient’s spine, lowered down, and then again with minimal body tilt, the concertina can be pulled out flat. If signs and symptoms suggested a spinal or pelvic injury, then make sure 999 are aware of these injuries, and seek advice from them.

Click on the link or copy and paste the address into your browser. https://www.youtube.com/watch?v=rO3nyflejsY

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