Re: Hypothermia and medical-legal aspects of first aid/consent
Norman J. MacLeod (gaelwolf@SSNET.COM)
Mon, 1 Apr 1996 23:32:45 -0500
ADVANCE NOTE - This post becomes rather uncompromising in some spots.
That's because I am highly concerned about the overall low level of
emergency medical training amongst the Scout Leaders in most countries.
If you read this all the way through, and it maked you feel a little bit
uneasy or insecure, PLEASE, PLEASE, PLEASE enroll yourself in a
Wilderness First Responder emergency medical course as soon as possible.
You could save the life of one or more of your Scouts if you do. If
you don't, you might have to live with yourself after a Scout you are
reponsible for becomes disabled or dies and you know it would have
turned out differently, if only...
As I follow this thread, I find that some folks are very knowledgeable
about hypothermia, and that there are others who have a few gaps in
their familiarity with the subject. The latter bit is quite troubling to
Hypothermia is best dealt with when prevented. This includes adequate
food and non-alcolic, non-caffeinated drink. Both of these need to be
consumed at much higher quantities if you are on an outdoor activity
than when you are sitting around the house.
In cooler or wetter weather, you need to layer your clothing, with outer
layers taking the weather into consideration. Cotton outer clothing,
especially denim (jeans are made of this type of fabric) can be lethal,
as wet cotton will help remove heat from the surface of the skin up to
about 240 times as rapidly as heat is lost from bare skin in dry, still
However, in order to be fully prepared for preventing, identifying,
and/or treating hypothermia, you need adequate information and training.
My WWW ste (URL below) has a link where you can download a comprehensive
PowerPoint presentation on hypothermia. There are links from the
downloading page where you can obtain PowerPoint viewers (for free) as
well. While this version does not include some of the Advanced Life
Support (ALS) items, it has everything else, and will provide you with a
great deal of information that has not been covered in this thread - we
are, after all, talking about a rather complicated process...
In my opinion, based partly on several years of SAR experience, there is
no excuse for not gaining all the knowledge you can about this killer. I
know this is a rather uncompromising experience, but I don't think many
of you have ever had to carry a child's body out of the bush when he
should never have died.
One important point that has not been covered very well in the
discussion on patient consent as it applies to hypothermia. Anyone who
has severe hypothermia where he or she is no longer shivering as a
result of a dropping core temperature has a significantly altered mental
status. This is where we have to assume "implied consent" as the severe
hypothermia victim is no longer likely to be thinking rationally enough
to comprehend the consequences of refusing treatment.
Hypothermia victims should NEVER be anything cold to drink. However,
once shivering becomes too severe to control, you should NOT give them
anything warmer than normal body temperature either.
Reluctance to provide body to body contact warming when there is no
other reasonable method of re-warming is inappropriate. This may well be
the ONLY life-saving warming method you have available, and you could be
found negligent for witholding it. With a group of Scouts, the training
you provide them should include the possibility of having to use this
technique, despite society's "druthers". We are talking about a true
life or death situation here...
Besides - if you have one member of your group with obvious hypothermia,
you probably have at least a few others who either have milder
hypothermia, or will have soon.
Once you have a case of severe hypothemia on your hands, you have a REAL
problem. For instance, you need to be careful about how you provide the
re-warming, since use of excessive heat internally (hot drinks or food)
or externally (such as sitting close to a roaring fire) can be fatal.
This is why you need to know as much as possible about hypothermia...
In very severe cases of hypothermia, such as when someone has fallen
through the ice and has been in the water long enough to become fairly
unresponsive, you need to handl ethe victim VERY gently, because victims
with very low core temperatures can go into ventricular fibrillation
(VF) (where the heart quivers without a co-ordinated beat) if you handle
them roughly. Unfortunately, VF with a very low core temperature does
not respond well to CPR... The flip side of this low a body temperature,
though, is that the hypothermic brain can go without effective
circulation without damage for many minutes longer than it can when the
body temperature is normal.
Yes, this is very scary stuff!
Prevention is FAR better than getting to a point where treatment becomes
You should have a couple of hypothermia thermometers with you whenever
you take Scouts on activities, especially if you will be away from the
nearest road by more than a few minutes' walk. This is pretty much the
same as a normal rectal thermometer, excpet that it will measure
temperatures much lower than the thermometer you usually use to measure
fevers. Your local emergency room or emergency medical response service
will have catalogues that you can use to order these from if they are
not available at the local drug store.
When you are deciding what first aid course to take, you need to be
aware that most courses available in your community are going to be what
might be called "street first aid" - where easy access to ambulance
response is a core assumption. There are many additional things you need
to know in order to take care of people when you have to factor in the
several hours it may take a rescue team to get to your injured Scout or
Leader deep in the woods.
Wilderness First Responder, St. John's Ambulance Wilderness First Aid,
and Wilderness EMT courses are available now, along with similar courses
in many other countries. These are the courses you, as a Leader or
senior Scout / Venturer should be taking. The extra knowledge you gain
can easily save your own or someone else's life in a remote area.
Street first aid, while adequate if you never go into the bush, just
ain't going to cut it when you get far away from where you left the car.
Everyone in your Troop/Company/Unit/Post should be carrying a good first
aid kit in their day-pack or backpack, depending on the activity. Even a
really good kit will only weigh in at about a kilogram (couple of
pounds). I find that many Groups go out into the bush with only the
barest minimum of first aid supplies. While it is possible to use just
about anything to improvise, it's better to actually have the Real Thing
when someone gets hurt.
Now, I realise that what I am asking will take time and effort. However,
all I ask is that you consider the alternative. If you are going to be
leading young people into the outdoors, shouldn't you shoulder the
responsibility of learning whatever you need to in order to be able to
take care of someone in your Group who becomes injured? While some of us
have done what it take to be prepared, I wish more would make a real
effort to bolster their knowledge and training.
Try this Scouting Link in your WWW browser:
Includes "The Serious Side of Scouting" pages where we take
on subjects such as ADD and survival training courses
for Scouts and Leaders, along with much, much more!
All pages optimised for use with the Netscape Navigator.
Terry Howerton Sakima Group, Inc. SCOUTER Magazine Kansas City