Battlefield Trauma-Induced Hypothermia: Transitioning the Preferred Method of Casualty Rewarming

Abstract

For centuries, cold and wet weather has affected military combat operations leading to tremendous loss of manpower caused by cold-weather-related injuries including trench foot, frostbite, and hypothermia. The initial battlefield management of hypothermia in military personnel had not advanced significantly following many wars and conflicts until 2006. The aim of this review is to: 1) provide an overview of trauma-induced hypothermia (TIH); 2) highlight the Department of Defense strategy for the implementation of a hypothermia clinical management program for battlefield (prehospital) casualties; 3) highlight the research and development of the Hypothermia Prevention and Management Kit (HPMK) as the preferred field rewarming system for battlefield TIH; and 4) emphasize how the HPMK can be easily transitioned to the civilian sector for active rewarming of both accidental and TIH patients. The HPMK is ideal for those working in civilian Emergency Medical Services and austere prehospital care environments. This kit is a low cost, lightweight, small dimension commercial product that can provide effective passive management or active rewarming for both accidental (primary) and trauma-induced (secondary) hypothermia patients.

The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition

“…Steps to prevent hypothermia and the risk of hypothermia-induced coagulopathy include removing wet clothing, covering the patient to avoid additional heat loss, increasing the ambient temperature, forced air warming, warm fluid therapy, and, in extreme cases, extracorporeal re-warming devices [420–422]. Recently, the use of a hypothermia prevention and management kit has been advocated [423]. This kit is a low-cost, lightweight, low-volume commercial product that sustains 10 h of continuous dry heat with an oxygen-activated, self-heating liner and provides thermal insulation due to the multi-layer composite construction of the outer shell.…”

Wilderness Medical Society Clinical Practice Guidelines for the Out-of-Hospital Evaluation and Treatment of Accidental Hypothermia: 2019 Update

“…The HPMK was part of the JTS theater-wide strategy for battlefield casualties and has been used extensively in military operations to decrease mortality from trauma-induced hypothermia. 65 –67 System effectiveness (net body heat gain) generally depended on the mass of the insulation enclosure. 63 The 3 commercial systems were heavy and bulky and therefore only applicable at a point of care or if they could be delivered by sled or vehicle.…”

Successful Field Rewarming of a Patient with Apparent Moderate Hypothermia Using a Hypothermia Wrap and a Chemical Heat Blanket

“…The US military now mandates the use of an HPMK to prevent trauma-associated hypothermia for all litter-evacuated casualties. 5 This recommendation was based on a study using a human torso model, which found less heat loss using an HPMK when compared to other methods of heat conservation, including the Ready-Heat CHB alone and a forced air method (3M Bair Hugger, St. Paul, MN). 6 A civilian study compared a CHB with other active methods of heat conservation, such as warmed intravenous fluids, during transport of trauma patients.…”