Wilderness Medical Society Practice Guidelines for the Out-of-Hospital Evaluation and Treatment of Accidental Hypothermia

Zafren, Ken; Giesbrecht, Gordon G.; Danzl, Daniel F.; Brugger, Hermann; Sagalyn, Emily B.; Walpoth, Beat H.; Weiss, Eric A.; Auerbach, Paul S.; McIntosh, Scott; Némethy, Mária; McDevitt, Marion; Dow, Jamie; Schoene, Robert B.; Rodway, George W.; Hackett, Peter H.; Bennett, Brad L.; Grissom, Colin K.

doi:10.1016/j.wem.2014.09.002

Cited by 93 publications

(55 citation statements)

References 99 publications

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“…Defibrillation may be required, but is rarely successful in victims with core body temperatures below 28°C 24. Vasoactive and antiarrhythmic drugs may also be ineffective in patients with hypothermia with core body temperature below <30°C 38. Importantly, reversible causes of traumatic cardiac arrest, such as hypovolaemia and tension pneumothorax, must be considered and appropriately treated 63.…”

Section: Resultsmentioning

confidence: 99%

“…Staging systems have been developed to facilitate treatment of accidental hypothermia 38. One such staging system is the Swiss hypothermia classification system (abbreviated to HT).…”

Section: Resultsmentioning

confidence: 99%

“…Ideally, a core temperature is obtained which aids in determining appropriate treatment 36. Rewarming should nevertheless be initiated on-scene in order to attenuate further cooling and after-drop 38. Exogenous heat sources, such as chemical or electrical heat pads and blankets may be applied to the axillae, chest and back where conductive heat transfers most efficiently 74.…”

Section: Resultsmentioning

confidence: 99%

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The prehospital management of avalanche victims

Kornhall

Martens-Nielsen

2015

J R Army Med Corps

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Avalanche accidents are frequently lethal events with an overall mortality of 23%. Mortality increases dramatically to 50% in instances of complete burial. With modern day dense networks of ambulance services and rescue helicopters, health workers often become involved during the early stages of avalanche rescue. Historically, some of the most devastating avalanche accidents have involved military personnel. Armed forces are frequently deployed to mountain regions in order to train for mountain warfare or as part of ongoing conflicts. Furthermore, military units are frequently called to assist civilian organised rescue in avalanche rescue operations. It is therefore important that clinicians associated with units operating in mountain regions have an understanding of, the medical management of avalanche victims, and of the preceding rescue phase. The ensuing review of the available literature aims to describe the pathophysiology particular to avalanche victims and to outline a structured approach to the search, rescue and prehospital medical management.The most frightening enemy was nature itself…. entire platoons were hit, smothered, buried without a trace, without a cry, with no other sound than the one made by the gigantic white mass itself.

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Section: Resultsmentioning

confidence: 99%

“…Staging systems have been developed to facilitate treatment of accidental hypothermia 38. One such staging system is the Swiss hypothermia classification system (abbreviated to HT).…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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The prehospital management of avalanche victims

Kornhall

Martens-Nielsen

2015

J R Army Med Corps

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“…A 0.25°C difference in core temperature is also within a level of detection that is clinically important. For example, the upper clinical thresholds for mild hypothermia is 2°C lower than typical resting core temperatures (Zafren et al 2014). All statistical analyses were completed using a computerized statistical software package (GraphPad Prism version 6 for Windows, GraphPad Software, La Jolla California USA).…”

Section: Data and Statistical Analysesmentioning

confidence: 99%

Two nights of sleep deprivation with or without energy restriction does not impair the thermal response to cold

et al. 2015

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PurposeIn persons completing exhaustive daily exercise, sleep and energy restriction have been highlighted as risk factors for hypothermia in cold environments. The present study therefore sought to determine the effect of sleep deprivation (SDEP), with and without energy restriction, on the thermal response to cold. MethodsIn a random order, ten recreationally active men (means ± SD: age 25 ± 6 y, body fat 17 ± 5%) completed CAT Tre (P = 0.78). In contrast, perceived thermal discomfort during the initial hour of the CAT tended to be greater after SDEP and SDEP+ER (P ≤ 0.1). ConclusionSleep and energy restriction, at least as evaluated within this experiment, should be considered minimal risk factors for hypothermia. The greater perception of cold discomfort at the same body temperature suggests that sleep and energy restriction may actually reduce cold injury risk, as people are likely to engage earlier in normal behavioural cold adaptation.

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“…Otherwise, patients may be erroneously pronounced dead on site, rescue collapse may be missed, or unnecessary chest compressions may be performed in a stage III hypothermic victim, which may precipitate ventricular fibrillation (Brugger et al, 2011;Pasquier et al, 2014). The thorough 1-minute check may delay CPR, but is a worthy investment considering that survival of deeply hypothermic patients is possible even with prolonged periods without CPR (Althaus et al, 1982;Oberhammer et al, 2008;Zafren et al, 2014).…”

mentioning

confidence: 99%