Cold-Related Emergencies

Cold-related emergencies are typically the result of cold temperatures combined with a lack of insulation or protective clothing to deal with those temperatures.

How We Lose Heat

Radiation is the most significant and it involves the emission of infrared waves from the skin to cooler surroundings, similar to heat radiating from a stove.

Convection contributes the next most heat loss and occurs when warm air or water around the body is replaced by cooler air or water, carrying heat away.  Think of how nice a strong breeze is on a hot day.

Conduction is when there is direct contact with other objects. This is often a smaller concern, however, if your skin is in contact with a surface that absorbs heat easily like water, metal or cemet, conduction becomes a much larger concern. 

Evaporation is responsible for another large portion of heat loss under normal conditions and becomes the only effective cooling mechanism when the environment is warmer than the skin.  It includes sweat evaporation and moisture loss from the lungs during breathing. 

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

If at any point someone starts showing signs of hypothermia or frostbite, call 911 immediately to activate EMS. Attempt to find warm shelter to keep the patient as comfortable and as warm as possible until help arrives. Monitor for airway, breathing, and circulation issues. If at any point, the patient becomes unresponsive, goes unconscious, or is not able to breathe normally. Then begin CPR.

Treatment for hypothermia is a simple concept of just keeping them warm. It can become difficult in different situations though. This following list includes our priorities, but the order of when we conduct them may change based on the circumstances.

• Insulate the patient's body as best you can until help arrives.
• Move the patient to a warmer environment if possible.
• Remove any wet clothing and cover with blankets.

Using a Mylar Blanket

Unwrap the blanket and tuck it around the patient as much as possible as this can help with both convection and radiation heat losses. For smaller patients, blankets could be placed under the mylar so long as the blanket is dry and the mylar fits completely over the victim and blankets.

• 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.

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 re-freeze causing additional injury. However, it pays to know that you should only rewarm using water between 99 and 104 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. Also, rubbing or massaging the frostbitten portion could cause further injury, so it is best to let the body part warm up on its own.

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 protecting 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.
• Trauma. If a person is injured and they are facing issues with hypothermia, both conditions may worsen much quicker. Injured victims must be kept as warm as possible.