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[Kids talking] "Are you okay? I'm going to get help!" Now let's cover cold emergencies. In this situation we had two children possibly lost for a while, or played outside in bad conditions without enough warming and insulation in their clothing, and they started to feel the effects of hypothermia. You know, hypothermia begins when they start shivering. And once the body drops below 95 degrees Fahrenheit at the core temp, serious side effects begin to take effect. Dizziness, delirium, confusion, the shivering begins to stop. They become lethargic, weak, and then lose consciousness. Now the treatment for hypothermia is that we need to insulate their body as best we can while we wait for EMS to arrive, or remove them from the environment into a permanent warming area. If we're out in the field like this, obviously, we need to get help to come to us. We're going to have to help protect them while we're here. And the way we do that, a really good way is to have a waterproof blanket made out of Mylar. These are very common in first aid kits. And I strongly encourage you to have them whenever you have a first aid kit or an emergency kit that you have in your vehicle or with your rescue bag. These Mylar blankets are really designed to help reflect the heat of the patient. They're normally large enough that they would certainly be okay for a child and big enough for most adults. But our whole goal here is to actually have the patient roll towards us being extremely gentle with the child. If they have frozen parts, frostbitten parts, we don't want to agitate those parts any more than we have to as we could give crystals in their bloodstream. Make those kind of move and it could actually put them in cardiac arrest, so we want to be careful about that. Now what I'm doing here is I'm just untucking part of the blanket, and tucking the other half underneath the patient's body. What we're gonna do is we're gonna roll the patient then back onto this Mylar blanket. I'm gonna roll you over a little bit. We're gonna get you help here, honey, in just a little bit. I know you're super cold. Untuck the blanket on my side, and now they can lay on their back as we pull the rest of this blanket up and around them insulating their body. Go ahead and straighten your legs out, honey. I know it's super cold. As we wrap this all the way around, we're gonna try to seal it around their feet as best we can up under their chin. But you can't breathe through this stuff, so it's gonna be vitally important you leave room for them to be able to breathe. You don't cover their face. Now I'm gonna take another blanket and I'm gonna cover their body the rest of the way, over their feet and as far up as we can, tucking it all around underneath and as best we can and then waiting for EMS to arrive. You might notice that we have this little extra around their head. I might even tuck it around like that. Remember we lose an immense amount of heat through our scalp and through our head. We want to try to insulate that and keep them from losing any more heat than they already have. This is how we're gonna maintain this person that's in hypothermia until EMS or help arrives. But we're also gonna monitor for airway, breathing and circulation. If they stop breathing and go unconscious, we're gonna go straight into CPR until help arrives for as long as we possibly can. Remember it's important to protect ourselves as well, the rescuer. I'm kneeling in cold snow. It's lowering my body temperature. I might need to take my gloves off for dexterity so it'll be easy for my fingertips to start getting frostnip or frostbite. So remember scene safety for you as well. Now let's talk about the next piece, and that is frostnip, frostbite, and how we recognize it and then how we treat it. Out here in the field, we're not gonna be rewarming any frozen parts. Frostbite is indicated by fully frozen hard ends of their fingers, nose, cheeks, ears, toes, feet, hands. Those are the most common parts to freeze first. They're gonna be hard. They're gonna be white, and they're not going to have much feeling. If we have a person that's still able to walk but they have frozen parts, especially the feet, we're gonna try to walk them to permanent safety for as long as we can while their feet are frozen. We don't wanna take the time to rewarm if there's a chance that they're gonna refreeze again. We don't want to reheat or rewarm any frozen parts of the body with water hotter than 105 degrees. That's the maximum temperature before we then get into burns. And in my preference, it might even be a little cooler than that as that type of temperature can be extremely painful once the nerve endings come back and they can start feeling again. All rewarming attempts is extremely painful and so we sometimes will want, if at all possible in advance settings, for some form of analgesia to be applied through the rewarming, but not to the point where we suppress their ability to breathe on their own. It's gonna be important that we maintain this body temperature, rewarming, keeping their core temperature as high as we can until help arrives, and we can get them to permanent help where we can fully rewarm them and save their life.
Cold-related emergencies are typically the result of cold temperatures combined with a lack of insulation or protective clothing to deal with those temperatures.
Hypothermia begins to set in around the time the patient begins to shiver. And once the core body temperature drops below 95 degrees Fahrenheit, serious side effects ensue, including:
- Dizziness
- Delirium/confusion
- Lethargy
- Fatigue and weakness
- Loss of consciousness
How to Treat for a Cold-Related Emergency
Treatment for hypothermia is basically two-fold:
- Insulate the patient's body as best you can until help arrives.
- Move the patient to a warmer environment if possible.
Pro Tip #1: One of your best tools for helping you achieve number one above is a mylar blanket. They're common in first aid and emergency kits, and for good reason. They work by reflecting the heat of the patient and are big enough to cover most adults from head to toe.
Warning: Wrapping a patient in a mylar blanket should be done gently using the steps below. You want to make sure not to agitate any frost-bitten extremities. Plus, cardiac arrest is also a concern, as crystals in the blood stream can travel and wreak havoc.
Using a Mylar Blanket
- Carefully roll the patient onto their back and kneel beside them.
- Unwrap the blanket and tuck one end under the side of the patient's body farthest from you.
- Roll the patient away from you and onto the blanket.
- Untuck the blanket on the other side and wrap it around the patient.
Pro Tip #2: The patient may be in a fetal position to try and stay warm. Gently straighten their legs so the blanket can engulf them completely.
- Seal the blanket as best you can, but leave room for the patient to breathe, as mylar isn't breathable material.
- Put another blanket or coat over the patient. Cover the feet and tuck it in around the patient as best you can, including the top of the head.
Pro Tip #3: We lose a ton of heat through or feet, hands, and head, so make sure these areas are covered. Top and sides of head, not the face.
Keep the patient as comfortable and as warm as possible until help arrives. And continue to monitor for airway, breathing, and circulation issues.
If at any point, the patient becomes unresponsive, goes unconscious, or is not able to breathe normally, call 911 immediately and activate EMS. Then begin CPR.
Warning: Don't forget to protect yourself. When dealing with cold-related emergencies, you're likely putting yourself in the same environment that felled the patient. And since you're likely kneeling on cold pavement, in snow, and may be working with your gloves off for reasons of manual dexterity, pay extra care that you don't also become a victim.
Rewarming Body Parts in the Field
A clinical setting is the preferred location for rewarming, so don't worry about it, especially considering that frozen parts that have been warmed could freeze again. However, it pays to know that you should never rewarm using water hotter than 105 degrees Fahrenheit. Higher temperatures could burn the patient, not to mention the pain involved.
Rewarming is very painful, as the nerve endings begin to come back and the patient begins feeling again. Which is why a setting that can offer analgesics is the best option.
Recognizing Frost Nip and Frost Bite
The most common body parts to freeze first are the nose, cheeks, ears, feet, hands, and especially the ends of fingers and toes. When frost bitten, these parts will appear white, hard to the touch, and numb or nearly numb to the patient.
A Word About Cold-Related Contributing Factors
When it comes to cold-related emergencies, there are several contributing factors to be aware of, including the environment and the age of the patient.
Anyone can develop hypothermia; however, the risk factors below could put people at higher risk.
- A cold environment. Though, even if the ambient temperature isn't that low, it can quickly be made worse if the patient isn't properly protected from the cold, including the use of inappropriate clothing.
- A wet environment. The presence of moisture – perspiration, rain, snow, etc. – will increase the speed at which body heat is lost.
- Wind. Wind makes the environment a lot colder than the temperature indicates. The higher the wind chill effect, the lower the actual temperature.
- Age. The very young and very old usually have a harder time staying warm in cold conditions. Body mass, or lack thereof, is one concern, as is their ability to think clearly when it comes to removing themselves from that environment or better protect themselves with proper clothing. And in older adults, impaired circulation may also be a concern.
- Medical conditions. People with certain medical conditions, such as hypoglycemia, shock, and head injury, may be at higher risk of developing hypothermia.
- Drugs and alcohol. Alcohol and certain types of drugs can reduce a person's ability to feel the cold, or can impair judgment and impede rational thought, preventing the patient from taking proper precautions to stay warm.