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[Kids talking] "Are you okay? I'm going to get help!" Now, let's cover cold emergencies. In this situation we had two children possibly lost for a while, or played outside in bad conditions without enough warming and insulation in their clothing, and they started to feel the effects of hypothermia. You know, hypothermia begins when they start shivering. And once the body drops below 95 degrees Fahrenheit at the core temp, serious side effects begin to take effect. Dizziness, delirium, confusion, the shivering begins to stop. They become lethargic, weak, and then lose consciousness. Now the treatment for hypothermia is that we need to insulate their body as best we can while we wait for EMS to arrive, or remove them from the environment into a permanent warming area. If we're out in the field like this, obviously we need to get help to come to us. We're going to have to help protect them while we're here. And the way we do that, a really good way is to have a waterproof blanket made out of Mylar. These are very common in first aid kits. And I strongly encourage you to have them whenever you have a first aid kit or an emergency kit that you have in your vehicle or with your rescue bag. These Mylar blankets are really designed to help reflect the heat of the patient. They're normally large enough that they would certainly be okay for a child and big enough for most adults. But our whole goal here is to actually have the patient roll towards us, being extremely gentle with the child. Now, what I'm doing here is I'm just untucking part of the blanket, and tucking the other half underneath the patient's body. What we're gonna do is we're gonna roll the patient, then back onto this Mylar blanket. I'm gonna roll you over a little bit. We're gonna get you help here, honey, in just a little bit. I know you're super cold. Untuck the blanket on my side, and now they can lay on their back as we pull the rest of this blanket up and around them, insulating their body. Go ahead and straighten your legs out, honey. I know it's super cold. As we wrap this all the way around, we're gonna try to seal it around their feet as best we can up under their chin. But you can't breathe through this stuff, so it's gonna be vitally important you leave room for them to be able to breathe. You don't cover their face. Now I'm gonna take another blanket and I'm gonna cover their body the rest of the way, over their feet and as far up as we can, tucking it all around underneath and as best we can and then waiting for EMS to arrive. You might notice that we have this little extra around their head. I might even tuck it around like that. Remember we lose an immense amount of heat through our scalp and through our head. We want to try to insulate that and keep them from losing any more heat than they already have. This is how we're gonna maintain this person that's in hypothermia until EMS or help arrives. But we're also gonna monitor for airway, breathing and circulation. If they stop breathing and go unconscious, we're gonna go straight into CPR until help arrives for as long as we possibly can. Remember it's important to protect ourselves as well, the rescuer. I'm kneeling in cold snow. It's lowering my body temperature. I might need to take my gloves off for dexterity so it'll be easy for my fingertips to start getting frostnip or frostbite. So remember scene safety for you as well. Now let's talk about the next piece, and that is frostnip, frostbite, and how we recognize it and then how we treat it. Out here in the field, we're not gonna be rewarming any frozen parts. Frostbite is indicated by fully frozen hard ends of their fingers, nose, cheeks, ears, toes, feet, hands. Those are the most common parts to freeze first. They're gonna be hard. They're gonna be white, and they're not going to have much feeling. If we have a person that's still able to walk but they have frozen parts, especially the feet, we're gonna try to walk them to permanent safety for as long as we can while their feet are frozen. We don't wanna take the time to rewarm if there's a chance that they're gonna refreeze again. If we need to rewarm ourselves, use water that is between 99 and 104 degrees Fahrenheit. All rewarming attempts is extremely painful and so we sometimes will want, if at all possible in advance settings, for some form of analgesia to be applied through the rewarming, but not to the point where we suppress their ability to breathe on their own. It's gonna be important that we maintain this body temperature, rewarming, keeping their core temperature as high as we can until help arrives, and we can get them to permanent help where we can fully rewarm them and save their life.
Cold-related emergencies are typically the result of cold temperatures combined with a lack of insulation or protective clothing to deal with those temperatures.
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:
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.
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.
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.>
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.
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.
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.