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Knowing the warning signs of hypothermia and frostbite STORY BY JOHN ALLEN As you head outdoors for handgun deer hunting, ice fishing, cross-country skiing, snowmobiling, sledding, skating or any other winter activity, it's a good idea to know the signs of and take precautions against two of the season's biggest dangers—hypothermia and frostbite. While no reliable statistics are available on the number of hypothermia and/or frostbite cases treated each year because so many go unreported, the Illinois Department of Public Health (IDPH) reports that more than 700 Americans die each year from hypothermia. Dr. Dan Williams, president of SurviveOutdoors, Inc., an organization that teaches wilderness medicine to lay people, said medical treatment in a hospital setting is the ideal response to the maladies. However, because they frequently occur in places where such treatment isn't readily available, it's advisable to be prepared to deal with them until medical help can be reached. According to Williams, hypothermia is a total cooling of the body caused by prolonged exposure to cold, wind or water. He notes that all three factors need not be present, citing cases of elderly people becoming hypothermic while swimming in the ocean in Florida. "As you get older, your skin gets thinner," Williams said. "Skin is our biggest insulator. Whenever you get out of the water, your body
They may be having fun, but this trio could be at risk because they're not properly dressed for the cold weather.
is wet and cooler. People swim on hot days for that very reason." Public health officials note that older people are also at a disadvantage because their bodies don't adjust to temperature changes as quickly, and they may be unaware they're getting colder. They cite examples of people who became hypothermic without ever leaving the house, simply because their thermostats were set too low in winter months. Victims of hypothermia usually will exhibit a variety of symptoms: a body temperature of 94-95 degrees, slurred speech, fatigue, stumbling or wide gait, forgetfulness, drowsiness, a faraway gaze, weak pulse, slow heartbeat and shallow breathing. The most important sign, though, is shivering. According to the IDPH, "when the body temperature drops, the blood vessels near the surface narrow to reduce heat loss. Muscles begin to tighten to make heat. If the body temperature continues to fall, the person will begin to shiver. The shivering continues until the temperature drops to about 90 degrees. Temperatures below 90 degrees create a life-threatening situation." Williams, a physician assistant at an urgent care clinic in northern Illinois, said individuals showing signs of hypothermia should receive prompt treatment. Start by offering them warm, sweet drinks to replace sugars and fluids that have been depleted by shivering. Next, prevent further heat loss by replacing wet clothing should be replaced with dry apparel. Williams cautions that this should be done gently. Jostling hypothermia victims; especially those who are unconscious or whose core temperatures have dropped into the low 90s, can lead to life-threatening heart arrhythmias. Wrap the victim in a blanket, sleeping bag, tarp or tent. If these items are not available, use your body to warm the victim by laying next to him/her. The next step is to slowly warm the victim. Use heating pads or hot water bottles, if available, or build a fire and direct the warmth in the victim's direction. Do not give the victim alcoholic beverages. They suppress shivering, which Williams calls the body's best defense mechanism, since it generates heat. When the victim is able to be moved, go directly to a hospital. Do not give him/her a hot shower or bath, since this could lead to shock. "The knowledge that these individuals can be treated if they receive quick attention is of critical concern to those spending time in the outdoors, where these potential conditions can develop," Williams said. "Patients may appear clinically dead, but are able to be resuscitated if handled very carefully and properly warmed. 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." The second part of cold weather's one-two punch is frostbite. Though rarely fatal, frostbite cases appear more often than hypothermia. Williams said his clinic treats only one or two cases of hypothermia each year and about 12-15 cases of frostbite. Most of the frostbite injuries are minor, with only one over the past seven years resulting in a toe amputation. Body parts most susceptible to frostbite include fingers, toes and ears, and exposed areas of the face such as the nose, cheeks, chin and forehead, Williams said. Frostbitten skin appears white, stiff and numb. "Initially frostbite may not seem too bad, but it will after a few days," Williams said. Depending on the severity of the frostbite, he offered the following time line: 6-24 hours, large blisters appear; after
24 hours, small, bloody blisters" form; 9-15 days (severe cases), dark, ulcerous lesions called eschars appear. Eschars need to be removed surgically. To treat frostbite outdoors, Williams recommends wrapping the affected area and warming it gradually over a six- to eight-hour period. Tepid water can be used, but only if its temperature can be measured and if it's under 104 degrees. "It's a very fine line between warm and too warm," he said. Williams cautions against rubbing or massaging frostbitten areas and covering the affected areas with snow, as this will worsen the situation. Do not pop the blisters, and do not give the victim alcohol. Seek medical care as soon as possible. The best prevention against hypothermia and frostbite, Williams said, is dressing in layers, avoiding prolonged exposure to cold and carrying the right equipment to deal with danger. "Start with the feet," he said. "No cotton socks, because they hold moisture. Instead, use nylon socks, with wool or cotton socks over them. Wear waterproof boots, which shouldn't be too tight. An air gap between them and the feet keeps in the warmth." For the hands, he recommends waterproof gloves or mittens. "Mittens are much warmer than gloves," he adds. On the head, wear earmuffs, wool elastic bands, stocking caps or head socks. The remainder of the body also should be covered in layered clothing. The inner layer should be material that wicks away moisture from the body, such as polypropylene. The middle layers should be warm and not tight-fitting. The outer layer should repel wind and water, while allowing body moisture to pass through. As for equipment, Williams recommends carrying the following: a whistle, because it can be blown for longer periods of time than a person can scream and because the sound carries farther; a flashlight; a large, thick plastic bag that can be used as a raincoat, a shelter, a ground insulator or even a flotation device; a reflective mirror or compact disc for signaling; metal or waterproof matches for starting fires; packets of sugar for treating hypothermia; cotton balls; and petroleum jelly. He said all of these items will fit into a small fanny pack and might just make the difference between surviving an outdoor mishap or becoming another statistic.
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