So, What Would You Do? Really Cold and Wet!

enhanced-14292-1448034159-1Happy Friday everyone!  If you work a regular Monday-Friday job, you’ve made it!  If you work a job with less traditional days/hours, good luck!

On Wednesday, I posted a video from a backpacking trip that a YouTuber who goes by the name Scree Hiker posted.  Scree Hiker and a companion go for what appears to be an early summer/late spring hike in the Adirondacks, and promptly run into issues when a cold front/rain storm moves in.  They realize they aren’t properly equipped to deal with the weather and keep themselves warm, so they wisely decide to bail.  If you haven’t had a chance to watch the video yet, take a few moments and do so.  The scenery is gorgeous, and I now want to go visit the Adirondacks.  From a medical perspective, things start getting pretty interesting at about the 5 minute mark.

What I asked you to do is respond to this video as if Scree Hiker and his companion had decided not to go home, and you were the SAR/medical team dispatched to them.

So, here are some things I noticed:

  • Weather is important!  From the get go, you can see that conditions are shaky, as is pretty normal in early season trips.  Scree Hiker and his companion are wearing shorts, but they’re hiking in jackets and long-sleeves, so I’d guess the temperature low to mid-50’s.  You can see the wind steadily pick up in speed and intensity throughout the first five minutes of the video.  Chilly weather with stiff breeze is an excellent mix for hypothermia, and once you add rain, the recipe is perfect.
  • No Snow:  This video should serve as a powerful reminder that hypothermia can happen even when it’s not snowing!
  • Shorts:  Let me just start by saying that I really don’t think Scree Hiker and his companion were wrong to wear shorts; I would have as well.  I also don’t think they did anything wrong in this video.  I think if I had been in their situation, stopping and pulling on a pair of pants, with a hat and some gloves would have gone a long way towards maintaining warmth.
  • Shelter and Food:  I like that they moved to shelter and began eating and drinking.  I would have liked to see them move into a shelter situation that would have protected them from mist and rain blowing through; something like a tent or rigging a tarp as a wind block.  I recognize that moving to a fully enclosed shelter does make cooking with the stove a bit dicey.
  • Hypothermia progression:  As we know, hypothermia progresses in stages.  Mild hypothermia is characterized by controllable shivering, feeling cold, and loss of fine-motor function.  Everything I can see in this video suggests this first stage of hypothermia.  If not treated effectively, hypothermia will progress further.  Moderate hypothermia is characterized by uncontrollable shivering, changes in level of consciousness/disorientation, and “the umbles” — stumbling, fumbling, and grumbling.  Finally, patients experiencing severe hypothermia may not shiver anymore, due to the body’s energy reserves being exhausted.  The patient will be altered, and may behave in strange and irrational ways.  Additionally, the patient’s respirations and heart rate will slow.  Eventually, the patient will lose consciousness.

So, let’s say Scree Hiker had not made the prudent decision to bail.  We find them at the pavilion in the campground, huddled on the picnic table.  How will we manage them?

  • First, let’s assess airway, breathing, and level of responsiveness.  If they’re talking to us, they have an airway and are breathing adequately.  Are the shivering?  If they are, most likely they’re in mild or moderate hypothermia.  We’ll want to continuously re-assess airway, breathing status, and LOC as we treat these patients so we can track improvement or deterioration over time.
  • Let’s set up camp.  Re-warming patients is a longish process, and we want to make sure that nobody else on the rescue team becomes hypothermic in the process.  Let’s establish shelter that will protect us from the rain and the wind, and set up a spot to cook in.  Let’s get a couple of people in the cook tent and have them start boiling water, and making hot food and drinks.  We will probably plan to spend at least several hours, and possibly the night.
  • Let’s get our patients into shelter, and get their wet clothing off.  That wet clothing is sucking whatever heat they have left right out of their bodies, and we want to stop that process.  Then, let’s dress them in warm, dry clothing, preferably from their own packs.  We want to use their clothing so that we don’t take clothing that rescuers would need to keep themselves safe; we don’t want to potentially create another patient!
  •  Let’s hypo-wrap (one instructor I had used to say “burritoize the patient”) these patients in a sleeping back, tarp, and sleeping pad.  This will trap the patient’s body heat around them, and help protect them from further heat loss.  Once the cook tent has hot water, we can fill up some water bottles with hot water and tuck them into the hypo-wrap in an effort to add heat to the system.  Hot water bottles shouldn’t go against bare skin; wrap them in a shirt to avoid burning the patient.  If you don’t know how to make a hypo-wrap, here is a great video from our friends at Longleaf Wilderness Medicine:

 

 

  • The best way to warm these patients is to use their body to do it; in order to generate heat, the body needs fuel.  We’re going to feed them and give them hot drinks.  We want food that will provide fuel for several hours, so some protein, fat, and complex carbohydrates, not just quick burn simple carbs like sugar and candy.
  • The question we always get at this point is, “should someone get in the hypo-wrap with the patient?”  There is no clear answer.  It’s not proven not to work, and there are a lot of stories out there of people who have done this with good effects.  I would suggest that it’s a better use of rescuer resources to not tie up a rescuer by putting them in the hypo-wrap, and that drying the patient, insulating the patient, and feeding the patient will be more effective.
  • Prepare for rapid evacuation if warranted.  If the patients deteriorate, we will need to call for additional resources to evacuate them.  Severely hypothermic patients are fragile, and may go into a lethal heart arrhythmia called ventricular fibrillation if they are handled too roughly.
  • If properly treated, these patients should be able to hike out with the rescue team in the morning.

The best way to treat hypothermia is by preventing it in the first place; the second best way is by promptly recognizing the symptoms, and treating them before they get worse!  I give Scree Hiker lots of kudos for recognizing the start of a bad situation, and deciding to bail rather than trying to stick it out, and getting stuck in a bad situation.

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