Case Study 39

The Answer


  • Mild hypothermia (based on shivering, mental status, and measured temperature).
  • Mechanism for spine injury, unable to perform focused spine assessment.
  • Possible head injury.

The Plan

  • EMS has removed the patient’s clothing, wrapped the patient in blankets, and has patient in a warm ambulance. 
  • Spine precautions are in place: soft collar, patient supine on cot.
  • EMS is evaluating and treating the patient.


On wilderness medicine courses we often practice the hypothermia wrap in controlled conditions where a patient in dry clothing is placed into a sleeping bag, then wrapped in a vapor barrier. This plan does not fit this scenario, which is based on a real event. The scene is “unsafe,” not suitable for assessment and treatment. Wrapping the patient first in the tarp preserves the dryness of the sleeping bag and its insulation ability. Transport conditions are not ideal, but realistic.

Once a safe scene is found, in this case the back of the ambulance, assessment and treatment can proceed.

We also use the phrase “spine protection” in this scenario. This is new terminology reflecting rapidly evolving modern spine injury management concepts where backboards, straps and tape immobilization, and cervical collars are not necessary for all patients. In this case immobilization would have been impractical and regardless, the SAR responder providing hands-on protection of the cervical spine was within standards of care.  

End of the Tale

The patient had mild hypothermia that resolved in an hour with warm blankets and a warm ambulance and emergency room.  The patient had a concussion; there was no spine injury.

Interested in a cool educational website on hypothermia with Gordon Giesbrecht PhD? Click here.