Monday, December 18, 2006
Recognizing symptoms of hypothermia
Hearing the news yesterday about Kelly James, who died on Mount Hood (Full Story), I was reminded of my days in EMT training. I was also reminded of how little experience I've had treating cold related injuries because I worked in Atlanta. It's a rare year when we see more than a quarter-inch of snow.

I thought it might be a good time to refresh my memory, and yours, on how to spot hypothermia.

First of all, it's important to remember that you don't have to be stranded on a mountainside to get hypothermia, which strictly speaking is defined as a core body temperature of 95 degrees Fahrenheit or below. The condition is considered life-threatening at temperatures of 90 or below. But if you're very young or very old, you could have problems just being out in the cold weather. The biggest indicator of hypothermia is confusion.

The first thing to go as your body loses heat is your brain function. In fact, I read yesterday that once your body temperature drops below 95 degrees, for each additional degree of temperature loss, you also lose about 4 percent of your brain's processing power.

Other symptoms... If you start to slur your speech, feel very fatigued or lethargic or start breathing very slowly, you should try to get medical attention immediately.

If you're concerned that a loved one may be affected, the best thing to do is get him or her inside, out of the cold, and take off any wet clothes. Once you're inside, you can start the re-warming process, but be very careful to do it slowly... Blankets and hot tea will get you started, but it's a good idea to call for medical help.

There's a saying in the medical field: "You're not dead until you're warm and dead." Exposure to extreme cold can actually slow your heart and metabolic rates so much that they're virtually undetectable. With all your processes practically standing still, it's also possible to survive a longer time without breathing. If you come upon someone in this condition, you should begin CPR and rescue breathing immediately, and call 911 for help.
How were they sure that Kelly was dead. Dr Gupta said yesterdat hypotermic person can look dead although he is alive. Was he really dead? or Did he look like dead?

Myth #10
They are not dead until they are warm and dead.
This is always an interesting statement that does require a certain amount of common sense. In other words, there are limits. If you pull someone out from under the ice after 18 hours or dig them out of an avalanche after 24 hours, there is no hope of resuscitation.
Always, always, always, keep the rescue team in mind. Do not put their lives at risk in a heroic, dramatic resuscitation effort when the chances of recovering are zero.
Busted - It is a nice dramatic-sounding maxim, "not dead until warm and dead," but if they are found dead and have been dead for a while, they will remain dead. Please, do not put the lives of others at risk to appear to be a hero. Remember, as Murray Hamlet says: "You're never dead until you are warm and dead, unless you are cold and dead."
I feel that while this article is informative from a medical standpoint, from a practical standpoint it has minimal value. Once the listed symptoms have set in, most people are no longer qualified to make such judgments and will not usually make the appropriate decisions.

I always used one of the body's best clear indicators you are getting in trouble. When your teeth are beginning to chatter it is time to SEEK SHELTER NOW. This is a certain sign you body is moving into hypothermia. I read that once many years ago, and have found it to be very sound advice.

Wayne Sisk. - Outdoorsman
I think you all make very good points!

Teddy, I think John's post actually answers your question... The "warm and dead" rule really only applies to someone who - based on common sense - could still be alive. Meaning... if the average person could survive 6 minutes without breathing, someone who is cold could possibly last 10 or 15 minutes. As an EMT, if I were to come across somebody who hadn't been breathing for 15 minutes, ordinarily, I wouldn't think there was much hope of survival without significant brain injury. But in these situations, as clinicians, we are trained to realize that someone who is cold could have a better chance of survival after an extended period of time.

Once you're talking about days or even hours in a compromised position, there is very little hope.

That isn't to say that there is no hope for the two climbers that haven't been found, but once you stop breathing, ice and snow will only keep you going for so long.

To Wayne's point, it is absolutely essential to follow your gut when it comes to hypothermia! Chances are, you would not notice those symptoms in yourself, but I simply offer them in case you happen to notice them in others!

Thank you all so much for your comments, and keep em coming!
I was the victim of hypothermia in 1976 in Oregon, USA on a skiing trip, but I didn't recognize it for what it was.

In 1986, in January, I went steelhead flyfishing in a remote Oregon stream. It was about 18 degrees Fahrenheit, but I found the steelhead and the fishing was rewarding. I also experienced my second bout with hypothermia. In short, I woke up half naked with my face on a blueberry bush and my wader-clad boots in the river. The heat from my face melted the snow on the bush and the cold water woke me up. I was mystified to see that I had taken off my layers of upper body fleece clothing. I began shivering in the cold temperature. I knew that I had to get back to my car and get some heat or I would die. At this point, I was totally aware of my surroundings and experienced every moment with acute clarity. I managed to retrieve my clothes from all over the river bank, crossed the stream and returned to the car. I began to be worried when I couldn't control the shakes enough to hold the key and turn it in the door lock. After many tries, I finally got the key in, opened the door and used both hands to hold the key to turn the ignition. None of my fingers cooperated and I had to twist my entire arm to turn the key. After warming up the car, I managed to drive out of there and get home safely.

I did a lot of research after that and discovered what hypothermia was. I learned that the first thing to go is your sense of judgment. That's exactly what happened to me. I remember being too warm because of the snug fit of my fleece jacket, the hike to the stream and the excitement of hooking, fighting and running up and down the stream with ocean-fresh winter steelhead. I remember unzipping my jacket and feeling the cold air hit my bare chest like a hammer. I remember tearing off my clothes and tossing them on the ground and stumbling across the stream to the other side. I don't remember anything between that and the melting snow on my face. I know now that the perspiration on my chest just froze and my core body temperature dropped. I lost all sense and took off my jacket, shirt, fleece undershirt, etc. because I had lost my sense of self-preservation. I could have died by that stream, and believe that God saved me to go on to do many good things. But I can testify from personal experience that one cannot be too prepared for hypothermia. I have since pursued my favorite fishes in Alaska, Washington, British Columbia, Russia, and other US states and never encountered severe hypothermia because I did my research and took great care in preparing my trips, having a buddy, taking along the right foods, being weather-aware, etc.

I do remember another little thing. When I was lying on the bush by the river bank, a great peaceful feeling washed over me and said to me, this is not too bad, is it? I can honestly tell you that at that very moment, I didn't feel cold or hot and I felt very very much at peace.
Sanjay, your comment about "warm and dead" is very insensitive, and inappropriate, at a time when family members have lost a loved one, and possibly more. Just stick to the literature.
As someone who has treated several hundred hypothermia patients over the years, I would like to offer some simple information about cold weather injuries and prevention methods.


Please free to contact us if we can be of any additional assistance.

Clark Staten, Asst. Chief Paramedic (Ret)., Chicago Fire Dept.
It is possible to suffer from hypotermia in warmer climates and during the summer. A wet windy day or a dump in the lake from a canoe or boat is all you need. If you don't quickly get out of wet clothes, especially cotton clothes, your core body temperature will drop and you are at risk of hypothermia. I spend a lot of times outdoors as a volunteer with teenagers through the Girl Guides of Canada and I always carry around a supply of inexpensive solar blankets (cdn$1.25) and extra clothes to help ward off hypothermia not matter what the season.

Wilderness First Aider and Lifeguard qualified
Many more people die from hypothermia from cold water immersion than from being out climbing mountains or skiing. Ice water will totally incapacitate a person in a few minutes. Even 70 degree water will produce hypothermia in a lightly dress person. it just takes longer. Many of these deaths are listed as drowning but the root cause was hypothermia that prevented them from staying afloat.
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