As we head into the coldest months of winter, many states in the U.S. will experience below-freezing temperatures, in addition to sleet, snow and a host of other inclement weather conditions.
Though winter is not the only time first responders encounter cases of hypothermia on the job — as there are approximately 25,000 hypothermia-related deaths in the U.S. annually — cold weather conditions present significant increased risks for hypothermia-related injuries and deaths. Your team must remain prepared to treat airway emergencies associated with hypothermia this winter, with reliable equipment, protective materials and efficient strategies for keeping both themselves and their patients safe from adverse weather.
Hypothermia Causes, Stages and Treatment
Since humans are warm-blooded, we rely on systems of behavioral (efforts to reduce thermal discomfort) and physiological (sensory feedback to the brain) thermoregulation to regulate body temperature. Hypothermia occurs when the core body temperature falls below 35 degrees Celsius (95 degrees Fahrenheit), and results from prolonged exposure to the cold, certain drugs or underlying pathologic conditions.
The clinical features of hypothermia present differently in different patients, making it vital for medical professionals to understand and identify the stages of hypothermia to recognize the severity of a patient’s condition.
There are four stages of hypothermia. These include:
- Mild: Patient is alert but might have altered mental status, shivering, abnormal function and inability to care for themself (core temperature between 32 to 35 degrees Celsius, 90 to 95 degrees Fahrenheit)
- Moderate: Patient is exhibiting a decreased level of consciousness, may or may not be shivering (core temperature between 28 to 32 degrees Celsius, 82 to 90 degrees Fahrenheit)
- Severe: Patient is unconscious, not shivering (core temperature <28 degrees Celsius, <82 degrees Fahrenheit)
- Profound: Patient’s core temperature is <57.2 degrees Fahrenheit
Not included in these four main stages is “cold stress,” which refers to normal levels of shivering and body function and retaining the ability to care for oneself while body temperature is lower. Cold stress is indicated by an estimated core temperature of 35 to 37 degrees Celsius, or 95 to 98.6 degrees Fahrenheit.
If first responders are unable to measure a patient’s temperature in a prehospital setting, they should determine the severity of the patient’s condition based on clinical symptoms being exhibited and the hypothermia stages associated with those symptoms.
Airway Emergencies and Hypothermia
In some cases, such as patients suffering from co-occurring cardiac arrest and hypothermia, or severe hypothermia, responders must employ airway management techniques based on the patient’s respiratory status, or if the patient is suffering from persistent ventricular arrythmias. If possible, your team should avoid or delay intubation to allow for stabilizing and warming prior to the stress of intubation.
There are several steps your team should follow when treating airway emergencies in patients experiencing hypothermia. To prevent further heat loss, responders should remove patients from cold environments and any wet clothing, rewarming the patient’s body core temperature with blankets, heat packs and warm IV fluids. To avoid ventricular fibrillation scenarios that can result from cold weather and cold-water immersion, rescuers should instruct patients to avoid movement as much as possible while awaiting treatment. When the time is appropriate to intubate, be sure to suction the airway prior to the procedure to ensure a safer intubation.
How EMS Teams Can Stay Safe in Adverse Weather Conditions
So, how do you keep yourself safe when rescuing patients in adverse weather conditions? In addition to minding some of the risk factors for cold injuries, including fatigue, dehydration, malnutrition and tobacco use, first responders should reduce exposure to cold, wet and windy conditions as much as possible, and always keep extra protective clothing on-hand.
Your team has a responsibility to help keep patients safe from cold weather-related emergencies like hypothermia, but they also have a responsibility to keep themselves safe while on the job, too. Read SSCOR’s blog, The Dangers of Hypothermia, to learn more about how to avoid becoming a victim of hypothermia while taking care of your patients, and find out more about SSCOR’s EMS products here.
