Hypothermia is total body cooling, a bodily response which occurs when the right conditions are present such as wind exposure, wet conditions, where the body becomes very cold, coupled with total exhaustion. Individuals usually shiver for a period of time, then lose consciousness. Core body temperature can then drop to life-threatening levels. Patients may appear clinically dead, but area able to be resuscitated if handled very carefully and properly warmed. The knowledge that these individuals can be treated if they receive quick attention is of critical concern to those spending time in the out of doors, where these potential conditions could develop. Cold, blue, stiff patients with no palpable pulse are always to be treated as if they can be resuscitated, especially if hypothermia appears to be the major cause. Although it may seem surprising, it is not uncommon for individuals in Florida to become hypothermic when swimming in the ocean, as hypothermia can occur any time a situation is involved where core body temperature decreases. Hypothermia can occur outside of a cold environment. The very young and very old are more susceptible to hypothermic conditions. A person in their 6th to 7th decade of life down in Florida, for example, could while swimming in the ocean drop their core body temperature to a level that could potentially induce hypothermia.

Common signs and symptoms of depressed body temperature including the following:

• 94° Fahrenheit or less
• Stumbling or wide gait
• Slurred speech
• Shivering
• Faraway gaze

Hypothermia is suspected when you see an exhausted individual who is cold, wet, with a depressed body temperature.

Predisposing conditions

• Skiing
• Hiking
• Trauma
• Stalled cars during winter months
• Alcohol/drugs can definitely incapacitate an individual, thereby contributing to a hypothermic occurrence. Drugs and alcohol also suppress shivering, which is very important. Shivering acts as a heat generator for the body
• Immersion or becoming wet can exacerbate a situation
• Being very young or old is a contributing factor
• Nutritional deprivation
• Sugar depletion from the body will exacerbate hypothermia
• Endocrine diseases, diabetes for example, can predispose an individual to become hypothermic more quickly

Hypothermia Symptoms

Initial symptoms if still awake include expressed fatigue, slurred speech, poor decision-making, muscle weakness, shivering, an "I'm all right, I'm all right" attitude. These individuals can rapidly deteriorate to the point they have no respiration, no heart sounds, fixed and dilated pupils, are cold, stiff and blue.

Hypothermia causes significant liquid volume depletion, which limits the body's ability to shiver, and prevents exercise. Shivering depletes sugars from the body. Subsequently sugar and fluids need to be replaced and maintained.

In the outdoors, management of individuals demonstrating any of the above should occur quickly. An individual recognized as hypothermic should be offered warm, sweet drinks for liquid volume replacement, and these warm, sweet drinks are important to help generate heat. These individuals need to be kept dry and insulated. Shivering is the most effective way that the individual is going to re-warm in the out of doors.

IF A PERSON IS UNCONSCIOUS, GREAT CARE MUST BE TAKEN NOT TO JOSTLE THE INDIVIDUAL. EVEN IF YOU ARE TAKING OFF WET CLOTHES AND REPLACING THEM WITH DRY ONES, IT IS IMPERATIVE THAT YOU ARE VERY GENTLE. IT HAS BEEN DOCUMENTED OVER AND OVER THAT AN INDIVIDUAL WITH SEVERE HYPOTHERMIA CAN EASILY DEVELOP LIFE-THREATENING HEART ARRHYTHMIAS AND DIE IF PROPER PRECAUTIONS ARE NOT TAKEN AND JOSTLING AND QUICK MOVEMENTS OCCUR.

Subsequently, in the outdoors, it is important for these individuals to be handled very carefully as they are susceptible to arrhythmias. Always look to keep the airways open and the individual dry. No CPR until the person is in a vehicle. Apply heat packs, bottles or pads only to the bottoms of the feet and the palms of the hands. When you warm the skin all at once, it suppresses shivering, which is counterproductive, as once the shivering is suppressed, the core body temperature will decrease even further. So in outdoor wilderness management in the field, we do not want to stop the individual from shivering. The patient then should be transported immediately after for further care.

In review, it is important to be able to identify a hypothermic individual in an outdoor situation. It is important to note that shivering is equal to 4-5 100-watt light bulbs, as far as generating heat. Field assessment is important to determine how severely hypothermic an individual is. Obviously skin and body temperature are both important; however in an outdoor setting, measuring these might not be possible if the appropriate tools are not available.

In a severely hypothermic individual, DO NOT MOVE THE PATIENT. BE VERY GENTLE. The following are priorities:

• Stop the individual's temperature from dropping and slowly increase. It is important to maximize a safe warming rate. There are many ways to do this. There are external and internal ways to heat. In an outdoor situation, externally warming is obviously the most practical. Some other creative ways would be building a fire, use sleeping bags, tarps and tents to redirect the warm air towards the victim's body. This should be done slowly. Heating pads, if available, or simply laying next to the victim, using another's body warmth to warm the victim is beneficial in terms of re-warming and increasing temperature
• Remove wet clothing as gently as possible, without jostling the torso
• In the initial stages of hypothermia, exercising is not the best way to increasing temperature since you are burning up sugar and eventually this could be counterproductive.

Pre-hospital treatment:

• Replace wet clothes if possible
• Increase insulation
• Try creative vapor barrier
• External heat, if possible
• Heated air is good for the patient to breath in
• Warm drinks - sugar added or some type of sweetener added
• NO ALCOHOL

Severe hypothermia:

• No rough handling
• Change wet clothes to dry. Cut the clothes if necessary. Don't jostle the torso
• Maximize your insulation
• External heat is a must
• No drinks at this point in severe hypothermia
• Transport as gentle and as soon as possible to a treatment facility