Hypothermia Prevention In Trauma

Hypothermia prevention in trauma is a critical and often missed lifesaving piece of emergency medical training. Once a casualty’s massive haemorrhage is controlled, rescuers must turn their attention to the rest of the M-A-R-C-H pneumonic, specifically, to hypothermia prevention.

• Does the casualty have an open airway, or do they need help maintaining their airway?

• How are their respirations? Are they having trouble breathing due to a gunshot wound to the chest?

• Check the circulation: The easiest way to do this is to confirm a radial pulse and the ability to follow commands.

Even in hot climates, casualties get hypothermic

Then, as counterintuitive as it seems, even in places like Africa and India, which we think of as being hot climates, we have to consider hypothermia prevention. Why? Because cold blood does not clot. Hypothermia kills casualties and 9.3% of civilian trauma patients arrive at the hospital hypothermic. The typical body temperature is about 37ºC (98.6ºF). However, a drop of only 3 degrees, to 34ºC (93ºF) increases the casualty’s mortality by 28%. For a three-degree temperature drop, the casualty’s chance of survival is dropped by 1/4.

In Iraq and Afghanistan, where daytime temperatures soar to above 48ºC (120ºF), the military routinely places casualties in a Hypothermia Prevention & Management Kit (HPMK) or a Blizzard Bag, to ensure the casualty does not become hypothermic. 18% of casualties admitted to a combat support hospital in Iraq were hypothermic on arrival at the hospital. The TCCC Committee changed their guidelines in June 2020, emphasizing the need for hypothermia management.

HPMK’s, for example, include a heat pack that heats to 41ºC (106ºF). It’s basically a really high-tech, fancy space blanket that works. The Blizzard Survival Blanket is made out of a special material that is the equivalent of a medium-weight sleeping bag, in a package the size of a VHS cassette tape (if you don’t know what that is, you can Google it).

So, what is a well-trained first responder to do?

• Can you find a blanket or a coat to wrap around the casualty?

• Can you get the casualty off of the ground or off of a tile floor?

• Get the casualty out of wet clothing if possible and in a safe environment.

• Do you have a space blanket?

• Can you provide body heat to the casualty? If they can be comfortable, put them in contact with another person when the scene is safe.

• Get the casualty out of the weather – inside, in a vehicle, and to the hospital.