HYPOTHERMIA 

When March comes along, you might think that Spring has sprung. But old man Winter isn’t done with us yet. Although the month of March may exit like a lamb, it often enters like a lion. The Midwest and Northeast can attest to this fact from cold temperatures and heavy snows just in the last few days.

Even in March, winter storms (this one is named “Scott”) occur every year in the United States; Scott brought a foot of snow to some areas. Extreme weather can cause fatalities among the unprepared. In blizzard conditions, 70% of deaths occur due to traffic accidents and 25% from hypothermia from being caught outside during the blizzard.

The key word is “outside”. If a blizzard knocks you off the grid as Scott did to 60,000 people, you might be tempted to travel to someplace warmer, but that’s how most deaths occur from winter storms.

This winter has already seen deadly cold snaps where people have found themselves at the mercy of the elements. Whether it’s on a wilderness hike or stranded in a car on a snow-covered highway, the physical effects of exposure to cold (also called “hypothermia”) can be life-threatening.

Hypothermia is a condition in which body core temperature drops below the temperature necessary for normal body function and metabolism. Normally, the body core is between 97.5-99.5 degrees Fahrenheit (36.0-37.5 degrees Celsius). Cold-related illness occurs once the core temperature dips below 95 degrees (35 degrees Celsius).

When it’s exposed to cold, the body kicks into action to produce heat. Muscles shiver to produce heat, and this will be the first symptom you’re likely to see. As hypothermia worsens, more symptoms will become apparent if the patient is not warmed.

Aside from shivering, the most noticeable symptoms of hypothermia will be related to mental status. The person may appear confused, uncoordinated, and lethargic. As the condition worsens, speech may become slurred; the patient will appear apathetic, uninterested in helping themselves, and may lose consciousness. These effects occur due to the effect of cooling temperatures on the brain: The colder the body core gets, the slower the brain works. Brain function is supposed to cease at about 68 degrees Fahrenheit, although there have been exceptional cases where people (usually children) survived even lower temperatures.

PREVENTING HYPOTHERMIA

An ounce of prevention is worth a pound of cure. To prevent hypothermia, you must anticipate the climate that you will be traveling through and dress appropriately. You must include windy and wet weather in your calculations. Condition yourself physically to be fit for the challenge. Travel with a partner if at all possible, and have more than enough food and water available for the entire trip.

It may be useful to remember the simple acronym C.O.L.D. This stands for: Cover, Overexertion, Layering, and Dry.

Cover. Your head has a significant surface area, so prevent heat loss by wearing a hat. Instead of using gloves to cover your hands, use mittens. Mittens are more helpful than gloves because they keep your fingers in contact with one another, conserving heat.

Overexertion. Avoid activities that cause you to sweat a lot. Cold weather causes you to lose body heat quickly; wet, sweaty clothing accelerates the process. Rest when necessary; use those rest periods to self-assess for cold-related changes. Pay careful attention to the status of the elderly and the very young. Diabetics are also at high risk.

Layering. Loose-fitting, lightweight clothing in layers trap pockets of warm air and do the best job of insulating you against the cold. Use tightly woven, water-repellent material for wind protection. Wool or silk inner layers hold body heat better than cotton does. Some synthetic materials, like Gore-Tex, work well also. Especially cover the head, neck, hands and feet.

Dry. Keep as dry as you can. Get out of wet clothing as soon as possible. It’s very easy for snow to get into gloves and boots, so pay particular attention to your hands and feet.

One cold-weather issue that most people don’t take into account is the use of alcohol. Alcohol may give you a “warm” feeling, but it actually causes your blood vessels to expand; this results in more rapid heat loss from the surface of your body.

Alcohol and recreational drugs also cause impaired judgment. Those under the influence might choose clothing that might not protect them in cold weather.

TREATING HYPOTHERMIA

If you encounter a person who is unconscious, confused, or lethargic in cold weather, assume they are hypothermic until proven otherwise. Immediate action must be taken to reverse the ill effects.

Important measures to take are:

Get the person out of the cold. Move them into a warm, dry area as soon as possible. If you’re unable to move the person out of the cold, be sure to place a barrier between them, the wind, and the cold ground.

Monitor breathing. A person with severe hypothermia may be unconscious. Verify that they are breathing and check for a pulse. Begin CPR if necessary.

Take off wet clothing. If the person is wearing wet clothing, remove gently. Cover the victim with layers of dry blankets, including the head, but leave the face clear.

Share body heat. To warm the person’s body, remove your clothing and lie next to the person, making skin-to-skin contact. Then cover both of your bodies with blankets. Some people may cringe at this controversial notion, but it’s important to remember that you are trying to save a life. Gentle massage or rubbing may be helpful. Avoid being too vigorous.

Give warm oral fluids, but only if your victim is awake and alert. If so, provide a warm, nonalcoholic, non-caffeinated beverage to help warm the body. Coffee’s out, but how about some warm apple cider?

Use warm, dry compresses. Use a first-aid warm compress (a fluid-filled bag that warms up when squeezed), hand warmers wrapped in a towel, or a makeshift compress of warm, not hot, water in a plastic bottle.

These go in special places: the neck, armpit, and groin. Due to major blood vessels that run close to the skin in these areas, heat will more efficiently travel to the body core. Others areas you might warm include the hands and feet, but avoid applying direct heat to amy area. Don’t use hot water, a heating pad, or a heating lamp directly on the victim. The extreme heat can damage the skin, cause strain on the heart, or even lead to cardiac arrest.

WHEN THE POWER’S OUT

Given that car crashes cause the majority of deaths in a blizzard, a great place to be is in your home, even if the electricity if off. Assuming you don’t have a generator, you can still keep everyone warm by staying together in an inside room, preferably without windows.

Heat in the home can be conserved by shutting the doors of unused rooms and drawing blinds and curtains to add insulation. Stuff towels under the door to prevent loss of warmth from the room you’re using. If you’re using some form of alternative heat, however, make certain that there is reasonable ventilation and prepare for mishaps by having a fire extinguisher handy.

Sterno cooking fuel is an option as an emergency heat source; it’s not meant to have directly against you, but indirectly as a simple way to heat some water to place in containers.

(Note: Although I can’t find the exact page they refer to, Wal-Mart states that California warns that this product can expose you to chemicals which are known to cause cancer or birth defects or other reproductive harm. Certainly, ingesting it is a bad idea, but as an emergency heat source, it appears that the Sterno company itself says it’s safe for indoor use and recommends that preparedness folk keep some in their storage.)

Staying hydrated is important. You’d be surprised how much water a family uses, so fill the bathtub. Plumbing might be kept from freezing by allowing faucets to drip. Stock up on non-perishable food.

OUTSIDE IN A BLIZZARD

You’re not a bear, so you can’t hibernate through the cold weather; you’ll have to take measures to avoid getting stranded out in the cold. Many deaths from exposure are avoidable if simple precautions are taken
The first thing that you should do before planning a day outdoors in snowy weather is consult your weather radio for the forecast. If a storm is on the way, postpone your outing until the weather improves.

Dress appropriately and in layers. Each successive layer of clothing traps warm air near your body. Wool is the best material for staying warm. Unlike cotton, wool will stay warm even if somewhat wet, and wicks perspiration away from the skin. Wet clothing will cause you to lose body core temperature faster. Mittens will keep your hands warmer than gloves.

STRANDED OUTSIDE IN THE CAR

The first question you should ask before you get in the car in cold weather is “Is this trip necessary?”. If you don’t have to leave the house in a snowstorm, don’t.  If you do, drive as if your life depended on it, because it does. Don’t speed, tailgate, or weave from lane to lane. Make turns slowly and deliberately, and be careful to avoid quick stops and starts.

Let’s say that, despite your best efforts, you’re stuck on the road in a blizzard. Help may be on the way, but what if it isn’t? It’s important to stay calm and don’t leave the car. It’s warmer there than outside and you’re protected from the wind.

Wet snow can block up your exhaust pipes and cause carbon monoxide gas to enter the passenger compartment. You’ll need fresh air, but don’t crack a window on the side where the wind is coming from. If you’re in a group, huddle together as best you can to create a warm pocket in the car. Rub your hands, put them in your armpits, or otherwise keep moving; this will help your muscles produce heat.

Maybe you can dig yourself out, but beware of overexertion in extreme cold. You’ll sweat, and wet clothes are a main cause of hypothermia. If you have flares, use them to let others know you need help.

THE WINTER SURVIVAL CAR KIT

There are a number of items that you should always have in your car, especially in cold weather. These are meant to keep you safe if the unthinkable happens and you’re stranded without hope of rescue.

Your blizzard survival car kit should contain

-Wool blankets (for warmth; wool can stay warm even if wet)
-Spare sets of dry clothes, especially socks, hats, and mittens.
-Hand warmers or other instant heat packs (activated by shaking, they’ll last for hours)
-Matches, lighters, and fire starters to manufacture heat Flashlights and candles (keep batteries in backwards until you need them to extend life).
-Small multi-tool with blade, screwdrivers, pliers, etc.
-Larger combination tool like a foldable military surplus shovel (some are multipurpose and can be used as an axe or saw)
-Sand or rock salt (to give traction where needed)
-Tow chain or rope
-Flares
-Starter cables (for jump starts)
-Water and food (energy bars, MREs, dehydrated soups, candies)
-Baby wipes (for hygiene purposes)
-A medical kit and medications
-Tarp and duct tape (brightly colored ones will be more visible and aid rescue)
-Metal cup or thermos (to melt snow, make soup, etc.)

-Noisemaker (whistle) to signal for help
-Cell phone and charger, weather radio

A March storm can be as deadly as one in January. With a plan of action, a few supplies, and a little luck, you’ll survive even in the worst blizzard.

Joe Alton MD

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