COLD EMERGENCIES
BRRRRRR….
Objectives
 Review the pathophysiology of cold injuries
 Review the stages of hypothermia
 Review treatment of hypothermia, frostbite, and frostnip
in the pre-hospital setting
Case Study
 Your next call on this so-far uneventful New Year’s Eve
is to Death Valley (AKA: The Bottoms) where a person
is found on the ground. On arrival, you try to turn the
patient around, but he is stuck to the ground by ice that
formed between concrete and his body.
 Can you just get back into your almost-warm rig and
leave him to the Coroner?
 How long do you have to check for a pulse?
 What can cause him to lose body heat faster than
normal?
Hypothalmus – the Human
Thermostat
Normal Temperature
Regulation
Human Specific Responses
What prevents us from
adapting?
 Alcohol
 Malnutrition
 Drugs
 Age (young and old)
 Comorbid disease
 Unpreparedness
Cold Water Immersion
Cold Water Immersion Chart/Hypothermia Table
Water
Temperature
in Degrees F
(Degrees C)
32.5 (0.3)
Loss of
Dexterity
(with no
protective
clothing)
Under 2 min.
32.5 to 40 (0.3
Under 3 min.
to 4.5)
Exhaustion or
Unconsciousness
Expected
Time of
Survival
Recommended Paddling
Clothing
Always wear a PFD!!
Under 15 min.
Drysuit with neoprene wetsuit
& fleece under layers,
Under 15 to
neoprene booties, or mukluks,
45 min.
neoprene cap covering ears &
gloves/mitts.
15 to 30 min.
30 to 90
min.
Drysuit with neoprene wetsuit
& fleece under layers,
neoprene booties or mukluks,
neoprene cap covering ears &
gloves/mitts.
40 to 50 (4.5 to
Under 5 min.
10)
30 to 60 min.
1 to 3 hrs.
Drysuit with neoprene wetsuit
& fleece or polypro layers,
neoprene booties or mukluks,
neoprene cap covering ears &
gloves.
50 to 60 (10 to
10 to 15 min.
15.5)
1 to 2 hrs.
1 to 6 hrs.
Drysuit with polypro or
fleece layers or 3mm wetsuit
plus drytop, neoprene booties,
cap
60 to 70 (15.5
to 21)
2 to 7 hrs.
2-3mm Wetsuit or Shortie
2 to 40 hrs. with light paddling top,
paddling shoes, hat
70 to 80 (21 to
1 to 2 hrs.
26.5)
2 to 12 hrs.
3 hrs. to
indefinite
1-1.5mm Shortie wetsuit,
hydroskin or light paddling
top, paddling shoes, hat
Over 80 (Over
2 to 12 hrs.
26.5)
Indefinite
Indefinite
Swimsuit, paddling shoes, hat
•
30 to 40 min.
The effects are not the same for everyone. Use this table as a basic guideline for various water
temperatures. If water/weather conditions are rough and/or paddlers are inexperienced,
clothing one or two levels more protective should strongly be considered.
Original chart provided to University of Sea Kayaking by Shawn Baker and modified by Scott Shea
for the Maine Association of Sea Kayak Guides and Instructors.
The ECG of Hypothermia
Osborne J Waves
Treatment of Hypothermia
 Remove wet clothing
 Passive Warming
 Warm air
 Warm blankets
 Active rewarming
 Warmed IV fluids
 Warmed oral fluids when alert, oriented, and able to
maintain gag reflex
Cardiac Arrest in Hypothermia
 ‘They ain’t dead until they’re warm and dead!’
 Exceptions
 Under water greater than 1 hour
 Frozen body
 Other reason to not attempt
 Pulse check for 60 seconds
 Standard CPR, remember, drugs won’t work as well
until rewarming occurs
Frostbite
 The Cold version of burns
 Isolated cold injury to a body part
 Three degrees (just like burns)
Superficial Frostbite
Severe Frostbite
Severe Frostbite
Treatment
 Rewarming
 Avoid refreezing at all costs, even if delaying rewarming.
 PAIN CONTROL!
 Morphine 4-8mg IV
 Fentanyl 25-50mcg
 Treat as needed for generalized hypothermia
Trench Foot
Trench Foot
 Exposure to cold (not freezing), damp conditions
 Causes a decrease in circulation and soft tissue
damage
 High rates seen in WWI
 Can also see it in prolonged ops in EMS
 Keep the feet dry!
 Treatment is dry, clean, warm feet
 May require wound care if severe