Hypothermia

Hypothermia is the name given to the condition when the core temperature of the human body falls bellow the required normal operating temperature.  It is opposed by Heat Stroke which is the when the core temperature gets too warm.

If left to progress it is fatal.

Our normal core temperature is about 37 degrees centigrade (98°F) with a fluctuation of +/- 1.5 °C for men and 1.2°C for women.

As the core temperature falls, there are 3 distinct stages of hypothermia, each increasingly difficulty to recover from by re-warming.

Stage 1

When the core temperature falls by just a few degrees (as little as 5 °C), We enter the first stage of hypothermia.

At 35 °C to 32 °C we begin to show mild behavioral symptoms known as the “Umbles”

  • Mumbles
  • Stumbles
  • Fumbles
  • Grumbles
  • Stumbles

We must look out for these signs on others and ourselves.  People may show abnormal self concern or become irritable with no obvious cause.  If somebody is acting like this and it is out of character for them, it is time to stop and rewarm them.

Likewise if somebody goes quiet, it is time to take action.

At 34 °C, uncontrollable shivering sets in.  This is the body’s response in which it tried to generate some movement and therefore heat to rewarm it’s self.  This should never be ignored.  If you or somebody else is shivering uncontrollably, it is time to stop and take action to rewarm.  It should be remembered that alcohol and some drugs can inhibit this response.

Stage 2

At about 32°C the shivering stops, it has not worked so the body moves on to it’s next defensive measure.  At this stage, the casualty begins to become overcome by the symptoms and their ability to rewarm themselves is diminished.  This makes it very important to spot hypothermia early and take action straight away.

At 32°C and below, casualties begin to display the following symptoms

they may slur their speech, display reduced dexterity and have difficulty co-coordinating their arms and legs

  • Confusion
  • Slurred speech
  • Staggering around like a drunk person
  • Tiredness
  • Cold and pale skin (more than usual)
  • Fast, shallow breathing

These symptoms do not lend themselves to a well ordered, organised person and they may loose vital items such as their gloves or hat.

Stage 3

The next stage is accompanied by unconsciousness as the body continues to cool to around 30°C.  At this stage, if alone, the casualty becomes totally helpless and will likely die as they are unable to take any action to rewarm themselves let alone prevent further heat loss.

Vital signs weaken and and it may be very difficult or impossible to detect a pulse or breathing although they may actually still be alive as cooling of the body, as is used in some therapeutic treatments, leads to a general slowdown and a kind of preservation.  A doctor is required to pronounce a  hypothermia casualty dead although in a remote wilderness scenario, with no means to rewarm the casualty and hope of evacuation, the writing is on the wall.

Where

People often equate hypothermia to cold climates such as the Arctic or Antarctic.  This is not really accurate.  Hypothermia can get us almost anywhere.  Hypothermia comes into play when the air temperature gets to about 12 °C and lower or when people are just not wearing enough dry clothing.

It is actually very rare for people to succumb in these regions of extreme cold as just by being there, they are very likely to be aware, prepared and dressed accordingly.

The cure for hypothermia is to rewarm the body as restore the core temperature.

What to Do

  • Prevent further heat loss
  • Adjust clothing (tucking everything in helps a lot)
  • Remove anything that is wet – water conducts heat away form the body about 25 time faster than air, no clothing is often better than saturated clothing
  • Add additional layers and put a warm hat on
  • Seek shelter from the wind
  • If a cabin is available, go inside
  • Start a fire or stove
  • Get into a dry sleeping bag if available
  • If the situation demands it, a second, healthy person can get into the sleeping bag with the casualty, using their body heat to warm the sleeping bag and casualty.  Skin to skin contact is very helpful.  Men: It is not gay, just do it.
  • Ensure that they are well insulated from the ground with a foam mat or thermarest type sleeping mat.  Spruce boughs or other “springy”, dry vegetation will also work.
  • Use a second sleeping bag to wrap them in and then wrap a tarp around that to seal the warmth in and prevent the wind from stealing any heat from them.
  • Eat something, high sugar foods are best.  Digestion generates heat, it is extremely helpful.
  • Have a nice cup of sweet, sugar tea or just warm water if that is all you have.
  • Gently and progressively rewarm, do not introduce sudden high temperatures

What not to Do

  • Do not put the casualty into a hot bath – this can lead to cardiac arrest
  • Do not massage limbs
  • Do not use heating lamps or introduce other sudden temperature increases
  • Do not give them Alcohol to perk them up, this is dangerous
  • Rewarm them too quickly

As with most things, Prevention is better than the cure

Wearing layered clothing and adapting the layers to the conditions helps a lot.  For example, if you are walking or working hard, you will be generating heat.  It is important to take steps to ensure that you do not sweat and that excess heat can be released.  At this time, you want minimum layers on.

When you stop working, you will not be generating heat and will begin to cool, at this point you want to be putting layers on.

When you sweat in cold climates, that moisture will collect on your clothing and then freeze.  We don”t want this obviously, see this picture of me.

 

Cold weather clothing is a bit topic and will be covered in another post but for now I will suggest to you that hypothermia often occurs as a result of unpreparedness or as a result of a small mistake made early on that has cascaded into a larger, more serious problem now.

For example; Putting your gloves down on the cold snow or ice or dropping your hat onto the floor when doing something, that will just make your gloves and hat cold which will lead to cold hands and cold head which will lead to a lower core temperature.

Another example could be; Somebody has gone outside utterly unprepared and wearing inadequate clothing, perhaps out for a run so has only worn the minimum so that they do not overheat.  They twist an ankle and become unable to walk and have to spend more time outside than they anticipated.  In their immobile, weakened state, they are now vulnerable.

Certain demographics are more vulnerable than others however nobody is invulnerable.  Generally speaking, the very young and the very old are particularly vulnerable as is anyone who has become weakened by injury or fatigue.

Further reading can be found here in this PDF from the Department of Health and Social Services Division of Public Health Section of Community Health and EMS

For some reason that is link is hosted by the university of Manitoba so just in case that link does not work you can download it from me AlaskaColdGuidelines05

Another Israeli Bandage

I noticed some cheap Israeli bandages while shopping for something else on amazon the other day.  At about 3 pounds each I wondered what they were like so bought some.

As described in other articles, I feel that Medical knowledge and equipment is vital to us in Bushcraft, Survival, Outdoor Living and Expeditions.  When we work with razor sharp tools, we expose ourselves to risk of traumatic injury.  When we are in remote locations, we often do not have the ability to call and ambulance or get ourselves to a hospital in quick time.  Further to this, many of us strive for self sufficiency and self reliance as much as possible and with some simple knowledge, training and equipment, we can actually cope with some minor traumatic injuries without the need for specialist medical care.

Battlefield medicine shares something in common with Wilderness and Remote Medicine in that traumatic injuries often occur in extreme circumstances in remote locations.   This makes military battlefield medicine a worthwhile interest to us.

The seller does claim that these are genuine Israeli Defense Force (IDF) items but I cannot verify that.  They are in very good condition (brand new) but it is not clear how old they are.

I have found it to be a good idea when buying potentially life saving medical equipment to buy an extra one so that you can open the sterile packaging and see what it is like inside.  Finding out that something is terrible and inadequate in the heat of the moment while treating gushing wound is not the best time of place so it pays to spend that little bit extra so that you can be sure that what you are betting your life on is a good bit of kit.

A look at what is inside the packaging

These are not the famed “Israeli Bandages” that you may be familiar with, the ones that the US and British Armies have adopted as their own for use as a First Field Dressing (FFD) in combat life saving application.  They do have instructions written on the packaging in Hebrew though and the outer packaging is very good.

What attracts me to these other than the price, is the small sized package, they are about half the thickness and weight of a standard FFD which means that you can either carry more in place of the bigger ones or add some extra one in places where the bigger ones will not fit.

But are they any good at treating traumatic injuries?

I think so, yes.  Not having a traumatic injury on hand on this dreary, rainy Saturday afternoon, I had to forgo that particular test but I can say that the wound pad, the actual absorbent section looks and feels good.  Instead of the signature plastic “H” in the bigger Israeli bandages they just have normal cotton bandages for tieing off, this is fine as far as I am concerned as I carry both, I expect that I would opt for the small one first and then if some extreme downward pressure is required then i’ll move to an H bandage.

I did wonder how much blood that these small ones would absorb when compared with the bigger ones.  I used water in lieu of blood and found that the amount of water that it will soak up and hold is ¾ of a pint which is about 0.4 liters.  This is quite acceptable in my opinion as the big ones only hold 1 pint.

I am pretty happy with these and two of them have been added to my trauma kit

What more is there to say, they are priced well enough that you can buy a whole load of them, small enough that you can tuck them away in all sorts of places and they do a pretty good job of bandaging traumatic wounds.

I cannot foresee a Bushcraft scenario that might need this but the plastic packaging is designed to also be used as a chest seal when treating sucking chest wounds, normally associated with gunshots to the chest.  I suppose this could be useful if the need ever arose.

As always, This is not an advertisement, i’m not selling them, I don’t get anything from this but thought it worth mentioning them as a good item to have in your first aid, trauma or medical kit.

First Aid, Medical and Trauma Kit´s in Bushcraft Part 2

Following on from my earlier post about Trauma Kit´s and how, after an incident in which I cut myself quite badly, I decided to separate my First Aid Kit into two kits, one for minor to serious Trauma that can be reached for in an emergency and easily opened and the other, for all the general first aid type of thing.

Over the years, I have assembled quite a range of items that I have found useful from time to time while away on trips around the world and even at home.  This is my general First Aid Kit and I came up with the following considerations before building it

Considerations

  1. It must be small and light enough that it does not take up too much space and is not therefore a candidate for ¨weight saving¨ when I am looking to save weight
  2. It must be contained within a waterproof bag
  3. The Items within should allow me to keep body in reasonable condition in the event of a minor injury or sickness
  4. Some items have been added that are there simply to improve my quality of life
  5. Have enough items within that I can treat other people without running out of items for myself
  6. Be designed to work in conjunction with a separate Trauma Kit

Like the Trauma Kit, Our First Aid Kit must be configured to meet the likely threats that we will face and these may differ depending on what we are doing and where we are located.  This kit here is designed to be used in Temperate regions, in a Bushcraft type environment eg; somebody spending several days in a remote location, camping and far away from doctors and hospitals.

Items

 

  1. Lip Balm – having dry, sore, chapped lips can be very uncomfortable, I seem to experience this in cold or windy climates and have learned to make sure that I have some with me at all times
  2. Gloves
  3. Small LED head torch¨
  4. Tweezers, sharp folding scissors and assorted safety pins – These are contained in a sealed bag to keep them together
  5. Shears for cutting clothes
  6. Surgical Tape for affixing dressings
  7. Elasticated support bandage – This is also useful for handling snake bites in tropical countries
  8. Oral Rehydration salts – Useful when sweating a lot or when you have diarrhea.  When the body looses fluid by sweating or diarrhea, it looses salts  that are essential for maintaining the sodium level in the body.  Replacing these is essential.
  9. Small tube of high factor Sun Block.  Even in cold climates, the sun can take a nasty toll on exposed skin, sun burn or even skin cancer are best avoided at all costs
  10. Antihistamine insect bite relief cream.  Useful when you are having trouble sleeping due to the infuriating effects of itchy insect bites.  This stuff is very effective.
  11.  A small ¨open and shake¨ hand warmer.  When very cold, treating cold injury or somebody in shock, It may not be possible to reheat them immediately, this can help to warm the affected area until a fire can be built
  12. Bandage designed for use around the hand
  13. Bandage designed for use around the elbow or knee
  14. General purpose bandage
  15. Triangular bandage – used for creating slings
  16. Bag of mixed medications.  At the moment, this kit is configured for a temperate but Boreal environment, it is very cold, below zero.  The bag contains several courses of Ibuprofen, Paracetamol, Codeine, Dihydrocodiene for pain management, Loperamide for diarrhea, any regular medications that I will need and some Diphenhydramine as an antihistamine for allergies.  IN warmer climates I might include antibiotics and anti malarial medications
  17. 2 bottles of clean water for wound irrigation and eye wash
  18. Large, water proof plasters (band aids)
  19. Antiseptic wipes
  20. A range of compeed blister pads
  21. A range of plasters for cuts, including extra long finger plasters
  22. Low absorbent wound dressing, large
  23. Low absorbent wound dressing, small
  24. Steri Strips – for wound closure
  25. Burn Gel – for treating (cooling) minor burns in the absence of enough cold water
  26. Small water proof dry bag to store it all in
  27. Small lock bag to essentially double bag it all – everything goes inside this and then this goes inside the red dry bag.

Notes

Note that where practical, I have put separated the items and put them into their own smaller plastic bags, this helps to keep it all organised, clean and dry.

There is usually a small bottle of iodine in there.  I use a small atomiser so that I can spray a wound to disinfect it.

There are few items in this kit that can be used to treat trauma injuries, I have that covered in a separate kit which you can see here in part 1

A decent First Aid kit helps a lot but it does not compensate for a lack or training or knowledge on the subject.  I can´t recommend enough that you get some training on Wilderness First Aid, Rescue Emergency Care or Remote Medicine as a priority.  We don´t need this knowledge until we need it but when we need it, we really need it!

First Aid, Medical and Trauma Kit´s in Bushcraft Part 1

I gave myself a nasty cut the other day and it led me to take another look at the medical kit that I carry with me.  My kit was sufficient on the day but I identified a number of deficiencies and improvements that could be made.

Here is my cut, not the worst but it required attention, I could not just shrug it off and continue as it was producing a lot of blood and was somewhat open in nature and would needed to be closed.

To cut a long story short, I messed up, in-spite of years and years of using sharp tools to work with, I was sleepy and not feeling very well at the time and was complacent.  I was working at an awkward angle the knife slipped out of the work piece that I was carving and into my hand.  It didn’t hurt, at all in fact but I was aware that something had gone badly wrong.  So with only one good hand and the other dripping blood at an alarming rate I fumbled around for my first aid kit that was close to hand thanks to a habit that I have formed of always having a first aid kit with me when working with sharp things. 

It has to be said at this stage that I could not open and retrieve the items that I wanted to with one hand and when i used both hands, I got slippery blood on everything that made it even harder, you see, over the years several useful items have been added to my basic first aid kit, things that I have found useful and decided to carry around such as a small amount of pain medication, antihistamine cream for bad insect bites, Oral Rehydration salts, Sun Block, Lip Balm, Super Glue etc..  My First aid kit had become stuffed to bursting of useful things that can help with a wide range of scenarios from good health, pain management, blisters, small cuts, burns, and more serious bleeding and trauma wounds.

After it was all sorted out, I took a look at the bloody mess and wondered what I could have done better and if there were any improvements to be made.  It also did not escape me that the cut was within 5cm (couple of inches) form the Radial Artery in my left wrist.

I identified some areas of concern.

  1. An easy way to get into this kit and find the items that I wanted
  2. Enough absorbent material to handle the large amount of blood being produced by the wound
  3. Too much other stuff getting in the way eg; plasters (band aids), ointments, pills and other general first aid related stuff that was not needed in this time critical moment.
  4. No way to close an open wound, certainly not one handed either
  5. The First Aid Kit bag (a small dry bag) was too tight fitting, I had to shake it all out onto the floor

Most, if not all, commercially available First Aid kit´s cater for very basic first aid scenario´s and not for minor or even major trauma.

When working with sharp knives, axes and saws we are now exposing ourselves and each other to a new risk that is outside the scope of a normal first aid kit.  Those 9 triangular bandages and a packet of plasters (Band Aids) are not going to help much.

I already carried items designed to handle trauma but realised that it was too spread out and difficult to locate and use while under stress, in shock, bleeding and one handed, which is likely going to be the state that you are in should you also need to manage this scenario.

Let me just say that in all the years that I have been using knives, I have had 2 serious cuts, both of which were caused by my own complacency and both of which occurred on my left hand (I am right handed).   Simply put, most of the time while using a knife, it is your off hand that is at the highest risk of being in the way when the knife slips.

So what changes did I make?  All of my medical items were in one medium sized kit, stuff into a dry bag and often with an H bandage and Tourniquet attached to the outside as these are large items that will not fit inside.

I realised that I needed to separate those everyday first aid items and trauma kit items into two separate kits with the following philosophy in mind,

 

  1. Seconds count
  2. The kit must be able to treat minor and serious injuries in the absence of immediate evacuation to a hospital (in remote locations, this is not always possible)
  3. The main threat that the kit needs to address is knife, saw and axe wounds, not gunshots as this is not within our threat sphere
  4. It must be able to be opened and items retrieved one handed.
  5. It must be small enough that it can be carried readily without encumbrance .
  6. It must be light enough that it is not looked upon as an item to save weight on when there is a desire to reduce the overall weight of what I am carrying

 

When deciding which sized bag or pouch to use, it is helpful to first get together all of the items that you want to put in a bag and then buy a bag to meet that requirement.  The danger is that if you buy a bag or pouch first then you will just fill that up no matter what and worse still it may not be big enough.

 

I found two decent quality pouches for this and choose in the end to go with the Maxpedtion FR-1 Medical Pouch.  The other one that I tried was a One Tigress Admin Pouch.  Both were good but the Maxpedition FR-1 was slightly bigger (deeper) and therefore less of a squeeze to put everything in although it does all fit in both of them.  Another advantage of the FR-1 is that it has a grab handle at the top which is very useful when trying to get hold of it in an emergency.

 

I will start at the top left and work my way across left to right.

 

  1. Small Petzle LED headlamp
  2. Small roll of flattened Gaffer Tape (Duct Tape)
  3. Pair of gloves
  4. 2 packets of Celox ¨quick clot¨ haemostatic clotting agent.  Used for heavy arterial bleeding.  Note the ¨Tabs¨ of gaffer tape that I have added to make them easier to pull out of the kit.  When an artery has been cut, seconds really do count and fumbling around is a waste of time.
  5. Scalpel Blade + folding handle
  6. A selection of pre made suture kits.  Each packet contains a length of silk or mono filament with a little curved needle pre threaded.  These are for closing deep wounds.
  7. Forceps
  8. Needle nosed tweezers with an ear plug stuffed onto the end to stop them from piercing other things in the kit
  9. A cyalume stick for additional light when needed
  10. Tube of super glue, also used for closing wounds
  11. Big shears for cutting clothing away
  12. 2 H Bandages (Israeli bandages). Highly absorbent bandages with the ability to tighten down by means of an H shaped piece of plastic.  I have two because if the wound is enough to need one of these then it will certainly need a second one soon afterwards.
  13. 2 gauze bandages
  14. 10 packets of steri strips.  These adhesive strips that can be used for wound closures.  I have so many as I found that they tend to come off quite easily and require replacing frequently
  15. A selection of different sized, low absorbent dressings.  These are placed on the wound and bandaged over with item 13.
  16. A couple of butterfly stitches, similar in use to Steri Strips but a different size and shape which can be useful on different areas of the body where the other strips don’t work well
  17. A couple of antiseptic wipes.  For cleaning.
  18. A couple of plasters, I don’t know for sure what these might be used for but it seemed like it wouldn’t hurt to throw these in.
  19. Large waterproof plasters
  20. Small Low Absorbent dressings
  21. An airways / breathing mask.  Should this kit be used on somebody else, it is not unreasonable to foresee that they may, at some stage, stop breathing.  People are more likely to offer ¨the Kiss of Life¨ if they won’t get blood or vomit and whatnot on them.  I have so many of these things laying around that I threw one in, just in case.
  22. On the outside of the pouch, I have a CAT (Combat Application Tourniquet or TQ).  These are bulky so putting them on the inside was not possible but also, if you need a TQ then you will need it very quickly indeed and having it attached with bungee cord to the outside means that it can be retrieved very quickly.  There is some danger that it may be lost if attached to the outside so we must be mindful of this.

Conclusions

It all fit´s neatly inside and overall is a small package and is very light.  It should be noted that this is not a First Aid KIt.  It does not replace a First Aid Kit and complements my existing first aid kit.  What this does is ensure that I have life saving items easily available and close at hand, that can be used one handed, is not too big or too heavy, is configured to meet the risks associated with sharp tools and can treat a nasty injury in the absence of a hospital or the means to travel to a hospital immediately.

My main First Aid Kit is still very useful and important but it does not need to be as readily accessible and easy to sort through as this Trauma Kit so it can stay in the top pocket of my rucksack where it always lives and I can take the Trauma Kit out when I start using sharp tools.

You probably know this already but just in case you don´t, having a medical kit with you, trauma or first aid, does not compensate for a lack of training or knowledge.  It is extremely important that you know how to use the tools contained within this kit and indeed how to react to the things that the body does when injured.  I consider medical training to right up there as one of the most important skill´s that we can have.  It is my contention, that you should too

I often ask my students where their First Aid Kit´s are and invariably receive the same reply – ¨In my bag¨.  Your first aid kit is no good in your bag, which is often back at camp or ¨over there somewhere¨.  When you are working with sharp tools, you must have your kit close to hand so that when you or somebody else needs it, it is right there within arms reach so that no time is wasted while you search for it.

Get into the habit of picking up your first aid kit when you pick up that knife or axe.  Eventually this will become second nature and it will be there when you need it most.

Finally, Do not skimp, your life could be at stake here and you want the very best quality that you can find.  Your kit should be configured to meet the threats that you are most likely to face.  This is for working around sharp tools, it is not a general first aid kit, I carry one of those too which will be covered in another post.

A part 2 post will follow in which I will describe my main First Aid Kit and it´s advantages and disadvantages