Case Study 2

The Answer

Assessment

  • Patient is wet and shivering. 

The Plan

  • Remove wet clothing. 
  • Replace with dry.
  • Use a hypothermia wrap to prevent hypothermia.
  • Set up camp. Start a stove and build a fire.
  • Feed and hydrate the patient.
  • Dry the patient’s wet clothing.

Anticipated Problems

  • The patient becomes hypothermic.

Components

  • Sleeping bag 
  • Patient zipped into bag 
  • Patient in dry clothes with hat, holding insulated hot water bottle
  • Insulating Pad
  • Tarp/Ground Cloth

Comments

Many people believe that if you fall into cold water you are almost immediately hypothermic. Not the case, says Gordon Giesbrecht, PhD, from the University of Manitoba. Dr. Giesbrecht combines well-published research with extensive arctic expedition experience and a passion for educating people on hypothermia, frostbite, and cold weather survival.

When we immerse ourselves in cold water we immediately gasp and breathe rapidly. It’s shocking and it hurts. There is danger if our head goes underwater; at this point we may inadvertently inhale the water making the situation considerably worse. The key, according to Dr Giesbrecht, is understanding this response and controlling our breathing. Try to tread water slowly. Grab the edge of your boat or the ice and keep your head above the water. After a minute or two your gasping should subside and, as your skin becomes numb, the intensely uncomfortable cold sensation should wane.

We have another 10 minutes before our muscles become too cold to move effectively. We could use this time to get out of the water or to secure ourselves against drowning.

It would be another hour until our body temperature drops far enough to make us critically hypothermic. Dr. Giesbrecht’s simple message is “1 minute, 10 minutes, 1 hour.” We need to control our breathing and survive the first minute. We have 10 minutes to move carefully and thoughtfully and an hour before we will become gravely hypothermic. Knowing this, while we still need to promptly treat hypothermia, we know we don’t need to panic. This group modeled this by not becoming victims themselves, and promptly and carefully preventing hypothermia.

The hypothermia wrap is a sound field technique both to treat hypothermia, or, as in this case, to prevent it. Place a dry shivering patient in a dry sleeping bag and wrap with a plastic tarp to keep the insulation dry and reduce heat loss. Most patients will warm using the heat generated from the chemical and mechanical process of shivering. Warm sweet drinks provide the necessary calories to fuel the energy intensive shivering.

This group didn’t place a second person in the bag with the victim. We don’t have science showing us this helps more than a good hypo wrap and perhaps some warm water bottles. A cold patient doesn’t absorb much heat through their skin. The rescuer is really only a source of heat to warm the sleeping bag and may be more valuable on the surface: making camp and hot drinks, cooking dinner, and making sure everyone else on the expedition is safe and sound. Carefully move patient into hypo wrap.

The plan also includes feeding the patient sweet, warm drinks. We feed them to fuel their shivering. The key word here is sweet. Warm drinks are nice, but they don’t resolve hypothermia by themselves. The warmth of the liquid is comforting, but does not add a lot of heat. The value of the sweet warm drink is in the calories that fuel our metabolic fires, and fluid for hydration. 

Luckily, this patient ate a breakfast and a lunch not long ago and they are well-hydrated. With adequate calories they should be able to shiver themselves warm in the cocoon of the hypo wrap.

End of the Tale

Your wet clothing was quickly removed and replaced with your companion’s dry clothing, hat, gloves, and socks. You were placed in a sleeping bag with a second bag on top and then on top of a sleeping pad. The stove provided warm drinks and food, and hot water bottles. Building a fire added warmth, gave you a sense of comfort, and helped dry your gear. Hypothermia was prevented! You ate a big meal and drank a lot of hot chocolate. Once your gear is dry you can continue on your way, although this time you’ll take the long way around the lake shore.