Oxford Handbook of Expedition and Wilderness Medicine

Johnson, Chris; Anderson, Sarah M.; Dallimore, Jon; Winser, Shane; Warrell, David A.

doi:10.1093/med/9780199296613.001.0001

Cited by 12 publications

(47 citation statements)

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“…However, by increasing the evaporative resistance and limiting evaporative barrier to reduce evaporative heat loss. 2,[28][29][30][31] However, there is little scientific evidence of the effectiveness of these measures.…”

Section: Possible Mechanisms For Resultsmentioning

confidence: 99%

“…[24][25][26][27] If the patient is wet, most prehospital guidelines on protection against cold recommend the removal of wet clothing prior to insulation, and some also recommend the use of a waterproof vapor barrier between the patient and the insulation in order to reduce evaporative heat loss. 2,[28][29][30][31] In the field, however, the ability to remove wet clothing might be impeded due to harsh environmental conditions or the patient's condition and injuries. Also, encapsulation in a vapor barrier might restrict necessary access and monitoring of the patient during transport.…”

Section: Protocol and Monitoringmentioning

confidence: 99%

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Protection against Cold in Prehospital Care: Evaporative Heat Loss Reduction by Wet Clothing Removal or the Addition of a Vapor Barrier—A Thermal Manikin Study

Henriksson

Lundgren

Kuklane

et al. 2012

Prehosp. Disaster med.

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This is a published version of a paper published in Prehospital and disaster medicine.Citation for the published paper: Henriksson, O., Lundgren, P., Kuklane, K., Holmér, I., Naredi, P. et al. (2012) "Protection against cold in prehospital care: evaporative heat loss reduction by wet clothing removal or the addition of a vapour barrier -a thermal manikin study" Prehospital and disaster medicine, 26(6): 1-6 URL: http://dx.doi.org/S1049023X12000210Access to the published version may require subscription. Abstract Introduction: In the prehospital care of a cold and wet person, early application of adequate insulation is of utmost importance to reduce cold stress, limit body core cooling, and prevent deterioration of the patient's condition. Most prehospital guidelines on protection against cold recommend the removal of wet clothing prior to insulation, and some also recommend the use of a waterproof vapor barrier to reduce evaporative heat loss. However, there is little scientific evidence of the effectiveness of these measures. Objective: Using a thermal manikin with wet clothing, this study was conducted to determine the effect of wet clothing removal or the addition of a vapor barrier on thermal insulation and evaporative heat loss using different amounts of insulation in both warm and cold ambient conditions. Methods: A thermal manikin dressed in wet clothing was set up in accordance with the European Standard for assessing requirements of sleeping bags, modified for wet heat loss determination, and the climatic chamber was set to -15 degrees Celsius (°C) for cold conditions and +10°C for warm conditions. Three different insulation ensembles, one, two or seven woollen blankets, were chosen to provide different levels of insulation. Five different test conditions were evaluated for all three levels of insulation ensembles: (1) dry underwear; (2) dry underwear with a vapor barrier; (3) wet underwear; (4) wet underwear with a vapor barrier; and (5) no underwear. Dry and wet heat loss and thermal resistance were determined from continuous monitoring of ambient air temperature, manikin surface temperature, heat flux and evaporative mass loss rate. Results: Independent of insulation thickness or ambient temperature, the removal of wet clothing or the addition of a vapor barrier resulted in a reduction in total heat loss of 19-42%. The absolute heat loss reduction was greater, however, and thus clinically more important in cold environments when little insulation is available. A similar reduction in total heat loss was also achieved by increasing the insulation from one to two blankets or from two to seven blankets. Conclusion: Wet clothing removal or the addition of a vapor barrier effectively reduced evaporative heat loss and might thus be of great importance in prehospital rescue scenarios in cold environments with limited insulation available, such as in mass-casualty situations or during protracted evacuations in harsh conditions.Henriksson O, Lundgren P, Kuklane K, Holmér I, Naredi P, Bjornstig U: Protection a...

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Section: Possible Mechanisms For Resultsmentioning

confidence: 99%

Section: Protocol and Monitoringmentioning

confidence: 99%

Protection against Cold in Prehospital Care: Evaporative Heat Loss Reduction by Wet Clothing Removal or the Addition of a Vapor Barrier—A Thermal Manikin Study

Henriksson

Lundgren

Kuklane

et al. 2012

Prehosp. Disaster med.

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show abstract

“…The exact aetiology of AMS, widely considered a precursor to more severe altitude illnesses, is also poorly understood. [6][7][8][9] Acute mountain sickness, high-altitude cerebral oedema and high-altitude pulmonary oedema Altitude illness is characterised by tissue hypoxia and oedema, particu larly in the brain and lungs. This is the result of a complex interplay of hydrostatic pressure differences due to hypoxic vaso motor changes, and increased capillary permeability through release of agents such as vascular endothelial growth factor and hypoxia-inducible factor 1-alpha (HIF-1-α).…”

Section: Physiology Of Altitude Acclimatisation and Aetiology Of Higmentioning

confidence: 99%

Acute high-altitude illness

Hofmeyr

Tölken²,

Decker

2017

S Afr Med J

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“…Although many expeditions may wish to be accompanied by a qualified expedition doctor, medics from fields such as nursing, prehospital or military field medicine and physiotherapy with appropriate skills and training can and do provide excellent care in the field. [8] Indeed, the breadth and depth of wilderness experience of the individual may be of more relevance than their specific medical qualification, and for some wilderness activities that carry a low risk and are without lengthy delays for evacuation, an expedition member who has been trained in advanced wilderness first aid may suffice.…”

Section: Expedition Medic Qualifications and Competenciesmentioning

confidence: 99%

“…These The expedition doctor who prefers reading textbooks should consider the focused manual, Expedition and Wilderness Medicine, by Hudson and Knox, [11] the practical and comprehensive Oxford Handbook of Expedition and Wilderness Medicine, edited by Johnson et al, [8] or the definitive encyclopaedia in the field, Auerbach's Wilderness Medicine. [9] …”

Section: Resources For Expedition Medicsmentioning

confidence: 99%