Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

Potentially Reversible Causes – Hypothermia

I suppose that I should stop procrastinating and complete start the potentially reversible causes of cardiac arrest.

Working through the potentially reversible causes mnemonic, COLD PATCHeD,[1] the first letter is C, the first word is COLD, so this should make it pretty clear that the C refers to being too coldhypothermia.

C for Hypothermia.

But first, let me describe someone progressing from a normal healthy 14 year old to an unconscious hypothermia patient. Almost the full spectrum of temperature change.

At that age, many feel invulnerable. Riding a bicycle to the library is just a normal way to get around. Living on a long steep hill, riding much faster than the cars is inevitable tempting. Traveling fast in cold weather leads to wind chill factor effects. The wind chill factor means that the wind speed amplifies the feeling of cold. This also amplifies the process of heat loss.

From the Wind Chill Chart,[2] we’ll use 60 miles per hour to calculate the wind chill, because the chart only goes that high. Traveling up to 60 MPH on that hill is not difficult. The big problem is drivers of automobiles, who don’t look before turning. It only takes one. That was not the problem on this day.

A minute at zero degrees wearing a loose fitting down jacket, thin gloves, and no hat. Invigorating if you don’t prolong it. From the steep hill, there is a longer, more gradual hill. this allows you to prolong the contribution of gravity. Then the up hill part. This should cause enough heat production to ward off hypothermia, but not on this day. The energy is not there. The pedaling is not as coordinated as it should be. Lacking the energy to pedal and the coordination to ride, pushing the bicycle becomes the next best means of travel. Still up hill. Shivering. At that time, there are few businesses or residences in the area, but giving up on the trip to the library is not really an option, yet. The library is nice and warm. They even have a good selection of books. Worst case – call for a ride home from the library. Worst case.

Switching to the side of the road facing oncoming traffic, since there is no possibility of riding any more. Now having trouble just walking in a straight line and way too tired. Don’t know how much longer this went on, but near the top of the hill, continuing was no longer an option. Not even shivering any more. The first house has some lights on inside. Knock on the door.

Unable to speak without dramatically slurring the words. The door is slammed shut, but there is no energy to continue. Don’t have the coordination to keep moving. Don’t really care at this point, because that is what hypothermia can do to you. Slump to the ground and wait.

Not really choosing to wait. Not caring. Not continuing.

Some people show up and get dragged inside. This is different. Not the usual bicycle ride. Not the usual trip to the library.

A mask is placed over the face. A bag being squeezed.

Next thing I remember is waking up in the hospital. The doctor can’t figure out what is wrong.

Doctor For Whom Temperature IS Confusing – What did you take?

Young RM – I was cold.

DFWTIC – Don’t lie to me. What did you take?

Young RM – I was very cold.

Repeat ad nauseam. Apparently the doctor went to a medical school that had not been introduced to the wonderful medical advance – the thermometer. If only there were an organization, like JCAHO, to make sure the clueless complied with a check sheet to be able to diagnose the obvious.

Just kidding. Everybody should realize that JCAHO exists to help the incompetent continue their careers.

I’d much rather have competent people providing care, than an organization that coddles the least common denominators. Least common denominators need to be remediated or terminated, but definitely not coddled.

That day I had a scared housewife call 911 the local emergency number, because in that county it took until the Clinton administration for them to get the various corrupt volunteers fire chiefs to agree to allow such progress despicable usurpation of their fiefdoms. Fortunately, the housewife was the wife of one of the ambulance volunteers and familiar with the numbers for the various departments.

Hypothermia comes from the Greek for low temperature. Cold. How cold is cold? When dealing with a hypothermic cardiac arrest, or severe hypothermia, a body temperature less than 86° Fahrenheit (less than 30° Celsius or centigrade). In EMS, we often do not carry a reliable thermometer, so how can we tell? Symptoms.

Treatment priorities are:

1. Stop the person from becoming colder.

If the patient is at all wet, this means get the wet clothes off of him, dry him off, then worry about warming him up.

You can try to warm the patient up while he is still wet. You can also try to fly by flapping your arms. Trying isn’t going to do it.

If you don’t dry the patient off, you might as well just drive a stake through his heart. Unless he is dry, he is losing more heat into the moisture than you will replace. Except maybe if you set him on fire. Just make sure you turn the oxygen off, first. And open some windows, burning patient leaves a really nasty smell.

What about #2? You only gave us one priority.

As far as EMS is concerned, that is all that really matters, unless you have extended transport times.

Assuming you have dried the patient off, they do not appear to be cooling down, now what?

2. Assuming that you have done a good job of protecting them from getting colder. Warm them up.


My apologies for the comments made, at 2:48 and 2:58of the video, by one of the people looking at this. It is not uncommon for people to use these words to demonstrate that they are overwhelmed by what is going on.

The last couple of minutes show the survivors being pulled to the side of the river. Earlier the video showed a couple of people with the appropriate life vests in a metal row boat paddling around, looking ready to capsize. They did not seem to rescue anyone. The video showed a bunch of people carrying an inflatable row boat, that similarly was not able to rescue anyone. If you use boats as a part of a rescue, will you be any better prepared? Maryland/DC/Virginia does not get weather like this often, so it is not surprising that they did not do a good job navigating around the ice. They describe it as the worst storm in decades.

Notice the guy who jumped in the water, swam out to one survivor, and pulled her to shore. He was told to get behind the fire trucks. He is wet and needs to be dried off. He needs to be kept from getting cold. They sound as if (my interpretation of the comments) they are more worried about him making the professional rescuers look bad.

Everybody who was rescued was rescued by someone who appeared to be breaking the rules.

The helicopter probably should no have been there. Initially, visibility was very poor. They were involved, at least partially, in the rescue of every survivor. The by-stander, who jumped in and swam to the woman trying to drown, was just a by-stander. He was astute enough to realize that everybody was just going to watch her drown. No equipment was close enough to reach her. The only way for her to survive was for someone to jump in. It should have been someone with a life preserver on.

It appears she was less than 20 feet from the side of the river. It also appears that she was incapable of staying afloat on her own. If this by-stander had not jumped in, what would everyone have said about her death? Maybe she would have been resuscitated, but that is assuming that somebody has a way of grabbing her. It does look as if there is one person in a turn out coat has a life preserver that he is dragging out to her. Would he have acted if the by-stander had not jumped in? Why wear turnout gear in the water? More mindless observation of rules.

At 4:30 of the video – They were all just standing there looking at us with their lights going and their sirens going and all that. And eventually I realized they had no way to get to us.

We do spend a lot of time exerting our authority by using our sirens. Not very helpful when the sirens cannot make a bit of difference, but that never seems to stop some people.

Some additional reading on hypothermia (all provide excellent information):

Circulation. 2005;112:IV-89 – IV-110.
© 2005 American Heart Association, Inc.
2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care
Part 10.4: Hypothermia


Hypothermia-Related Deaths – – United States – 1995 – 2002 and 2005
MMWR – Morbidity and Mortality Weekly Report March 17, 2006
55(10); 282-284
Free Full Text . . . . . Free PDF (type 14 or 282 in the page window when the pdf opens, depending on which it accepts. It begins at 14/32 pages.)

Other MMWR hypothermia pages


[1] Potentially Reversible Causes of Cardiac Arrest – Another, Better, Mnemonic
Rogue Medic

Again, thanks to JB of JB on the Rocks for this.
Cold (hypothermia), Oxygen deficit, ‘Lytes, Drugs, Pulmonary Embolus, Acidosis, Tension Pneumo, Cardiac Tamponade, Hypovolemia. I add epi and Distributive shock.

[2] National Climatic Data Center
Wind Chill Chart

Updated 8/12/2011 for links and formatting.