Ms. Carroll is an avid outdoors person and environmental activist. She was a Wilderness First Responder for 10+ years.
by Vicki Parker
If someone gets hypothermic, it should be readily noticeable - at first!. They will have the shakes or shivers. Their teeth may chatter. These are actually good signs that you have time to remedy the situation. The core body temperature is somewhere between 98 and 98.6. When the core temperature begins to drop, the body sends resources to help. The shivering and chattering of teeth is such a resource. By design, this will increase the metabolism in an attempt to raise the core temperature. But not for a prolonged period. In mild hypothermia, the core could be anywhere between 96 to 90 degrees, depending on the victim’s ability to withstand the cold. Some athletes, for instance, train to handle cold temperatures and their cores can drop lower without adverse affects.
For most of us, once the core starts dropping to a dangerously low temperature, the skin will become pale and cool to the touch. Urine output will increase because the body expends energy trying to keep urine warm and this is a waste of valuable energy during the threat of hypothermia. The more the core temperature drops, the more a victim of hypothermia will show signs of lethargy, confusion, and/or withdrawal. When the shivering stops and a person becomes quiet, this is a red alert!
To treat mild or manageable hypothermia, you should have the victim engage in activity. Ensure they are dry. Increase their food and fluid intake (warm it when possible). Increasing sugar will also help. These things work singularly or collectively to restore the core temperature in the absence of natural or artificial heat. If the victim continues to shiver or grows paler, bump things up a notch. Activity stimulates blood flow. The reason for food and fluid intake is that the body will begin the process of digestion which also increases the metabolism. But once the core drops below 90 degrees, a person is severely hypothermic and in a life-threatening situation. Unlike mild hypothermia where vital signs will remain stable, severe hypothermia will result in a decrease in pulse, respiration and blood pressure. Victims will be pain responsive only or non-responsive altogether. However, you should not assume death.
In cases of severe hypothermia it is essential to ensure the victim is dry. In a wilderness setting, you can package them for transport by packing them solid so that they cannot move. Jostling a hypothermia patient can cause v-fibrillation which means death. You do not want to administer CPR to a severely hypothermic patient for the same reason unless you are prepared to sustain CPR until you can reach definitive medical emergency care. Package the patient horizontally and never transport vertically.
We have heard many stories about hypothermic patients being on the brink of death and coming back to life. In fact, it is scientifically possible now to freeze a human body and ever so gradually bring the core temperature back to a point of restoring life. However, this can really only be done in an environment designed for that purpose such as a hyperbaric chamber. But the lesson to those assisting the victim, is don’t give up on your patient.
Every person and every set of events unfolds differently. There are cases where folks having given absolutely no warning signs or symptoms of hypothermia, and then lapsed into severe hypothermia rather suddenly. This can especially be true of divers or those in cold water. Be cognizant of the personality traits of those you share time with in the cold, and if they are acting out of character, treat it with medical urgency.
The following information is based on my certification and training as a Wilderness First Responder. Every circumstance is different. When at all possible, seek the assistance of a medical professional.