Hypothermia

SEAL Qualification Training in Kodiak

Photo by PO2 Erika Manzano

10/06/14
To Do Today:


1-10-1

1-10-1 is a simple way to remember the first three phases of cold water immersion leading to hypothermia and the approximate time each phase takes:

1 – Cold Shock. An initial deep and sudden Gasp followed by hyperventilation that can be as much as 600-1000% greater than normal breathing. You must keep your airway clear or run the risk of drowning. Cold Shock will pass in about 1 minute. During that time concentrate on avoiding panic and getting control of your breathing. Wearing a lifejacket during this phase is critically important to keep you afloat and breathing.

10 – Cold Incapacitation. Over approximately the next 10 minutes you will lose the effective use of your fingers, arms and legs for any meaningful movement. Concentrate on self rescue initially, and if that isn’t possible, prepare to have a way to keep your airway clear to wait for rescue. Swim failure will occur within these critical minutes and if you are in the water without a lifejacket, drowning will likely occur.

1 – Hypothermia. Even in ice water it could take approximately 1 hour before becoming unconscious due to Hypothermia. If you understand the aspects of hypothermia, techniques of how to delay it, self rescue and calling for help, your chances of survival and rescue will be dramatically increased.

Hypothermia

Without floatation, you will not die from hypothermia; you will drown first. The chilling effects of cold air and wind but water poses the greatest threat because it transfers heat 25 times faster than air. Depending on the water’s temperature, a victim can succumb to hypothermia within a few minutes.

The body’s sudden contact with cold water can also set off a body reaction known as the mammalian diving reflex. This reflex can greatly increase survival time (especially for women and children) in or under cold water. The mammalian diving reflex shuts off blood circulation, except for the flow between the heart, lungs, and brain. The small amount of oxygen left in the blood and lungs is saved for the body’s vital organs. This reflex has allowed people to survive being under cold water for an extended period of time. Therefore, a cold water drowning victim should be treated as if still alive even though the victim is not breathing, has no pulse, and may appear dead. WARNING: If the victim has no pulse and is not breathing, administer CPR immediately. If the victim does have a pulse but is not breathing, give rescue breathing only. If the victim has a pulse and is breathing, DO NOT give CPR—CPR could prove fatal. Continue first aid until medical help arrives. Check for a pulse for at least 45 seconds.

Symptoms

Once the body’s core temperature drops, the victim will show one or more of the following symptoms:

  • Violent and uncontrollable shivering as the body tries to warm itself.
  • Slow or slurred speech.
  • Disorientation or poor coordination.
  • Loss of skin color.
  • Blue and pinched lips.
  • A slowing or stopping of shivering that progresses into a rigid torso and limbs.

Survival Time

A hypothermia victim’s survival depends on the water’s temperature and the time spent in the water. A small body build cools faster than a large build. Children cool faster than adults.

Cold Water ExposureTo increase your chance of survival in the water, utilize the HELP position, or huddle position in a group, shown below:

huddle-300x240Extra clothing and inactivity (remaining motionless in the water) can also increase your survival
time.

Treatment

A hypothermia victim must be warmed to prevent further heat loss; therefore, treatment should begin as soon as possible. Consciousness of the victim determines the treatment that should be pursued. The following general treatment procedures are recommended:

  • If the victim is conscious, give the victim warm fluids. Give candy or sweetened foods to a victim who is able to eat.
  • If the victim is unconscious, place him on his back with his head tilted back to ensure an open airway.
  • DO NOT massage the victim. Massage can break blood vessels and create swelling, internal pressure, and blocked blood circulation.
  • DO NOT give alcohol to the victim. Alcohol lowers the victim’s body temperature.
  • Shock is a possibility, treat accordingly.
  • Seek medical help immediately/as soon as possible.

If medical help is not immediately available and can be removed from the water:

  • Get the victim into shelter.
  • Remove the victim’s wet clothing.
  • Put the victim in dry clothing.
  • Place the victim in a sleeping bag if one is available. It may be necessary to place another person in the sleeping bag with the victim.
  • Place as much insulation as possible between the victim and the ground.
  • Use hot water bottles, electric blankets, or blankets heated in an oven or by a campfire to warm the victim’s neck, groin, and the sides of the chest. CAUTION: DO NOT apply heat to extremities.

Treatment for mild hypothermia

If there is no way to get to a medical facility within 30 minutes, a mildly hypothermic person should be rewarmed as soon as possible. Shivering is a very effective process especially when well insulated. Shivering should be fueled by calorie replacement with fluids containing sugars. The sugar content is actually more important than the heat in warm liquids. Make sure that the person is capable of ingesting liquids without aspirating. Alcohol and tobacco use should not be permitted because they constrict blood flow.

External heat can be applied to high heat transfer areas such as the underarms and sides of the chest. Active heating of the skin is beneficial as it increases comfort, preserves energy stores and reduces cardiovascular stress

Light exercise such as walking produces heat but should only be attempted after a mildly hypothermic person is dry, has had calorie replacement and has been stable for at least 30 minutes. A warm shower or bath may be tolerated by an individual that is alert and mobile. However, this could be fatal to a moderate to severely hypothermic person and should be avoided in this case.

Treatment for moderate to severe hypothermia

This is a serious medical emergency requiring proper handling and treatment and in severe cases, immediate transport to a medical facility. There are some specific things you can do to help stabilize the individual prior to the arrival of proper medical attention.

Great care must be taken in handling a moderate or severely hypothermic person. Extraction from the water must be as gentle as possible to avoid precipitating ventricular fibrillation. Arms, hands, feet and legs should not be rubbed or manipulated. The person should be placed in a horizontal position and wet clothing should be gently removed and the body insulated as best as possible using dry blankets, clothing or other protective materials. If shelter is available, keep the person protected from the elements and insulated from the cold ground or snow using sleeping bags, clothing, back packs or even evergreen boughs.

If vital signs are present, the person should be rewarmed as previously described but not allowed to sit or stand until rewarmed. Under no circumstances should the person be placed in a warm shower or bath, no oral fluids or food should be given and no attempts should be made to rewarm with exercise, including walking.

In any hypothermic individual, core body temperature continues to decrease after rescue. It is called ‘afterdrop’ and may last many hours in a moderate to severely hypothermic person when no shivering is present and metabolic heat production may be only 50 percent of normal. Even gradual warming of the heart will help avoid cardiac arrest and ventricular fibrillation.


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