TREATMENT ON LAND FOR THE DIFFERENT LEVELS OF HYPOTHERMIA Search and Rescue Society of British Columbia ( Canada ) ( Kindly submitted by Mike Doyle )

Impending Hypothermia: Seek or build a shelter to get the person out of the cold, windy, wet environment. Start a fire or get a cookstove going to provide warmth. Provide the person with a hot drink (no alcohol, coffee or tea). Halt further heat loss by insulating the person with extra clothes, etc. This person should recover from the present condition quite quickly.

Mild Hypothermia: Remove or insulate the patient from the cold environment, keeping the head and neck covered. This prevents further heat loss and allows the body to rewarm itself. Provide the patient with a warm, sweetened drink (no alcohol, coffee or tea) and some high energy food. Limited exercise may help to generate some internal heat, but it depletes energy reserves.

Moderate Hypothermia: Remove or insulate the patient from the cold environment, keeping the head and neck covered. Apply mild heat (comfortable to your elbow) to the head, neck, chest, armpits and groin of the patient. Use hot water bottles, wrapped Thermo-Pads*, or warm moist towels. It is possible that you may have to continue this treatment for some time. Offer sips of warm, sweetened liquids (no alcohol, coffee or tea) if the patient is fully conscious, beginning to rewarm and is able to swallow. Patient should be seen by a physician.

Severe Hypothermia: Place patient in a prewarmed sleeping bag with one or two other people. Skin to skin contact in the areas of the chest (ribs) and neck is effective. Exhale warm air near the patient's nose and mouth, or introduce steam into the area. Try to keep the patient awake, ignore pleas of "leave me alone, I'm ok". The patient is in serious trouble, keep a close, continuous watch over the patient. Apply mild heat, with the aim of stopping temperature drop, not rewarming. If patient has lost conciousness be very gentle, as by now the heart is extremely sensitive. Always assume the patient is revivable, do not give up. Check for pulse at the carotid artery. If, after two minutes you find no pulse check on the other side of the neck for two minutes. If there is any breathing or pulse, no matter how faint, do not give CPR but keep very close watch for changes in vital signs. If no pulse is found begin CPR immediately, stopping only when the heart begins to beat or the person applying CPR can not carry on any longer without endangering himself. Medical help is imperative, hospitalization is needed.

Acute hypothermia The cold is so severe, that thermogenesis doesn't succeed in maintaining the equilibrium; the organism cools before the energy reserves are used and the blood volume modifications are set up. This kind of hypothermia occurs in injured alpinist or skiers, immobilized in snow, a crevasse or a torrent.

Sub-acute hypothermia This is hypothermia of an unharmed alpinist stuck in the mountain. It only appears when the energy reserves are used, so its onset is more or less rapid according to the patient's condition. Thermogenesis is very reduced, spontaneous rewarming is more uncertain and cooling can continue even with a minimal heat loss. Moreover, the liquid movements have time to appear and there is a big risk of hypovolemia during rewarming.

Sub-chronic hypothermia This is found in poor urban environments, in winter. Onset is very slow, the inter-compartment liquid transferts are important, spontaneously compensated by the patient, with a big risk of edema during rewarming.

* Thermo-Pad is a heat storage device that utilizes the science of super cooled fluids to produce heat. When Thermo-Pad is in its liquid state and at room temperature, it is a super-cooled fluid. When the metal disc in the pad is flexed, the pad freezes (crystallizes) and generates heat. Thermo-Pad uses the food grade salt sodium acetate which freezes (crystallizes) at 54o C (130o F) and can be super cooled in a sealed container to as low as -5o C (23o F). By flexing the metal disc in the pad, the super cooled liquid is made to freeze (crystallize) and the temperature of the pad increases to its freezing point of 54o C. The Thermo-Pad will eventually cool and must then be recharged in order to return the crystals to their super cooled state. Recharging is accomplished by simply melting the crystals and allowing them to cool. Although this can be done in a variety of ways, the simplest and safest method is by boiling the pad until all the crystals are melted. When the pad is completely liquid allow it to cool and it is ready to use again. This process of melting and activating may be repeated hundreds of times, as long as the vinyl remains sealed.