Hypothermia

Like a thief in the night, hypothermia can rob you of health – and even life.

By Randy DeVaul

As outdoor temperatures this season continue to drop, we should all guard against a common phenomenon that could turn catastrophic: hypothermia. If left unchecked or not taken seriously, hypothermia can lead to serious injury, illness – or even death.

Everyone at some time experiences some form of hypothermia. The word itself means below heat or, more specifically, subnormal body temperature. The body works hard to maintain 98.6 degrees F, the “normal” body temperature. With exposure to cold, the body reacts and attempts to warm itself. The following chart depicts what happens in cold exposure.

Internal/Core Body Temperature Body’s Reaction

98.6 F	Normal conditions
95 F	Body begins to shiver (mild hypothermia reaction)
92 F	Body stops shivering, reaction time slows, metabolism slows, thought processes slow (moderate hypothermia)
88 F	Sluggish, pale/ashen skin, slowing metabolism, fatigue (severe hypothermia)
85 F	Extremely sluggish, approaching unconsciousness

Notice that at 92 F, the body stops the shivering process even though it is getting cooler. As the core temperature drops, other signs are evident. The heart rate and breathing rate will slow and blood pressure will drop. The pulse rate slows and becomes irregular, indicating a serious change in the condition of the heart’s ability to supply oxygenated blood through the body.

Hypothermia can adversely affect performance without a person realizing it is happening. It does not require freezing temperatures. In fact, it commonly occurs at outside/ambient air temperatures of 55 F when victims aren’t properly dressed.

In a work setting, hypothermia can occur quickly. For example, an employee comes to work dressed appropriately, but the labor-intensive work level causes him to sweat and his clothing becomes wet. His energy output begins to decrease, he tires more quickly, and his internal body temperature drops due to evaporation, cooling temperatures and wet clothing. The employee is spiraling downward but doesn’t know it. His awareness level and concentration drops, making him a prime target for an injury.

A more serious hypothermic condition occurs when participating in outdoor activities away from work. Many people this time of year are involved in hunting, fishing, camping, boating, rock climbing and other activities that lend themselves to long-term outside exposure to the elements and even direct contact with water. If these activities are performed alone or in a remote location, there may not be anyone on hand to recognize the danger, creating a higher risk of hypothermia. For any activity that will last for hours at a time, hypothermia must be considered a real danger, and proper preventive steps must be taken.

Treatment for hypothermia
If hypothermia becomes a real threat to someone, how does one care for the patient?

Remember that shivering is one of the first signs of mild hypothermia, so just about anyone may experience its onset. If the condition is caught early on, treatment may consist of simply getting into a
warmer environment or drinking something warm such as tea, coffee or cocoa.

At this point, it is necessary to address the subject of alcohol: Don’t drink! Alcohol is a system depressant, causing the body’s functions to slow down. Exposure to cold also causes the body’s functions to slow down. Combining alcohol and exposure to cold will cause a dramatic slowdown of the body’s functions – including breathing, heart rate, circulation of oxygen, reflexes, mental thought processes and so on. So although alcohol may help you immediately feel warm, it will actually make you very cold in a short time.

In the early as well as late stages of hypothermia, additional treatment should include the removal of wet clothing to get it away from the skin and reduce the evaporative process. Heat always travels to cold, so wet, cold clothing will wick the heat from a person’s body and carry it away into the air. There will not be enough body heat to warm the atmosphere, of course, so anyone wearing wet clothing on a cool day is fighting a losing battle.

Later stages of hypothermia may result in a decreased level of consciousness. If that is the case, the patient cannot be given anything to drink as there is a danger of aspirating the fluid into the airway, causing the patient to choke or drown on the liquid.

The patient will need to be treated for shock due to the cold, and that brings up an interesting point about proper treatment. All too often, when rescuers treat for shock, they think about placing a blanket over the victims to keep them warm. For hypothermia, it is true that the patient needs to be gradually warmed, but the best location for the blanket may not be on top of but rather underneath the patient.

Once again, remembering that heat travels to cold, a patient lying on the ground or on a cold surface is getting the heat sucked right out of him. An insulator of some type must be placed between the surface and the patient to reduce that effect, so if only one blanket is available, place it underneath the patient. Actually, this would be true for treatment of shock in general, as a patient lying on a hot surface will need protection from the heat as much as insulation from a cold surface.

Make every attempt to get the victim indoors or protect the patient from the weather and wind. If the patient is unable to move on his or her own, take care that you don’t cause additional injury or stress. If you are unable to move the patient in a safe manner and help is not available, do everything possible to shield the patient from the elements until help arrives.

The patient needs to be warmed gently, so provide a heat source, if available, such as blankets, dry clothing or heat compresses. Do not apply hot materials directly to the skin! The patient may not able to communicate that something is too hot, and there is risk to burning the skin if not careful. If possible, place a thin layer of clothing or bandage dressing between the patient and the heated item to avoid direct contact with the skin.

Do not massage or rub a hypothermia victim’s limbs. As the body cools and the surface of the skin becomes more vulnerable to the cooling temperatures, cell damage under the skin can occur with any type of brisk rubbing or massaging. Simply stay with the warming process of dry clothing and the external heat of blankets or compresses.

If a patient is already unconscious, the rescuer must consider a couple of additional factors. First, make sure the patient still has an open airway, is breathing and has circulation (ABCs). If not, and the rescuer is trained to do so, begin CPR and/or rescue breathing. Second, a person with severe hypothermia may develop an irregular heartbeat or rhythm. This means the patient is susceptible to the heart stopping or the heart is not capable of circulating enough oxygen throughout the body. This can result in a heart attack, brain damage or both. Moving the patient can be deadly as any rough or sudden moves may cause his heart to stop.

Of course, if the patient is found unconscious, the rescuer must activate the 9-1-1 system to get professional medical treatment. The warming process may cause the patient to become more alert, but due to the advanced stage of the hypothermia (unconsciousness, for example), the patient is still susceptible to a heart attack up to 72 hours after the exposure. That is not something the rescuer or the patient can control – medical treatment is required. If the patient does become conscious while waiting for transportation and seems alert, the rescuer can attempt to give warm fluids.

When activating 9-1-1, as with any emergency, do not hang up the phone until the dispatcher indicates it is OK to do so. Cell phones are great, but not all cell phones that dial 9-1-1 actually call the closest or local 9-1-1 dispatcher. For example, a rescue call on a cell phone in New York may get a dispatcher in Virginia. The rescuer must quickly let the dispatcher know the location of the patient to ensure the correct emergency service is contacted and responding.

Finally, never attempt to transport a severely hypothermic patient to the hospital in a personal vehicle if there is any opportunity for activating the emergency medical services system. Road bumps, rough terrain or complications resulting from the exposure may create a life-threatening condition.

The best way to protect a person from hypothermia is to prevent exposure from occurring in the first place. There are a number of things a person can do to stay protected:

• Provide employee training. Include hypothermia discussions with active communication and reminders throughout the season and the workday.
• Wear a hat. A person can lose up to 75 percent body heat through an uncovered head; a hard hat is not enough – wear a hard hat liner under it. One note of caution: Quilted polyfil liners can melt if worn in a high-heat or welding environment; twill or cotton liners for those environments are a better choice.
• Wear layered clothing to remove or add as outside temperatures fluctuate.
• Wear the appropriate layered clothing. Use 100 percent cotton against the skin, followed by a cotton shirt, followed by an insulating material. Do not wear a one-piece insulating coverall, as there is no way to dress down when the temperature goes up and no way to remove wet clothing when the temperature goes down.
• Cotton is not a cold-weather fabric, so if you plan to work up a sweat in cooler temperatures, leave the T-shirt at home. Instead, invest in a synthetic fabric like Thinsulate for your first layer. These fabrics wick moisture away from the skin and stay fairly dry, even when you’re sweating. Insulating layers should be wool, fleece, pile or down in a jacket or vest. Finally, for really cold weather, a windproof, water-resistant jacket can be added as the top layer.
• Maintain adequate fluid intake. Water is necessary to keep cells hydrated and working properly. The act of breathing expels moisture from the body, as does sweating and evaporation.
• Maintain appropriate fluid intake. Do not subject the body to alcohol when recovering from the cold. Alcohol is a depressant, causing vital bodily functions to slow down. The cold is already causing a decreased metabolism; alcohol intake will make it worse. Also, alcohol is a dehydrator, so it will not replace or replenish lost bodily fluids.
• Drink warm fluids if possible, but in moderation. Too much caffeine can cause additional problems. Look for caffeine-free teas or hot chocolate, or lemon-flavored hot water. Warm fluids help the body maintain 98.6 F.
• Take short breaks in warmer environments during the shift, such as in the office, a heated vehicle, or in front of heat-generating equipment or heaters.
• Bring an extra change of dry clothing – shirt, socks and underwear – to maintain layers after removing wet clothing.

If already experiencing hypothermic effects, remove the wet clothing and replace with dry clothing or with other external heat sources, such as blankets. If available, place clothing in a dryer or next to a heat source to warm it up before putting it back on. A caution, though: Never place anything directly onto a heat-generating device or prevent appropriate air circulation from around the device – this could cause a fire or malfunction.

Hypothermia is a condition created by causes that no one can control. A person can, however, control exposure to those causes and eliminate or reduce risk to not experience hypothermia. If a person is not aware of the causes, it can sneak up on him like a thief in the night and rob him of body heat and, ultimately, life itself. Taking precautions now could save a person from such dangers.

Randy DeVaul ([email protected]) is a veteran safety professional/consultant and internationally-recognized author, writer, and speaker on Performance Safety principles and practices. Comments are always welcome.