Wilderness Medical Society Practice Guidelines for the Out-of-Hospital Evaluation and Treatment of Accidental Hypothermia: 2014 Update

Abstract

To provide guidance to clinicians, the Wilderness Medical Society (WMS) convened an expert panel to develop evidence-based guidelines for the out-of-hospital evaluation and treatment of victims of accidental hypothermia. The guidelines present the main diagnostic and therapeutic modalities and provide recommendations for the management of hypothermic patients. The panel graded the recommendations based on the quality of supporting evidence and the balance between benefits and risks/burdens according the criteria published by the American College of Chest Physicians. The guidelines also provide suggested general approaches to the evaluation and treatment of accidental hypothermia that incorporate specific recommendations. This is an updated version of the original Wilderness Medical Society Practice Guidelines for the Out-of-Hospital Evaluation and Treatment of Accidental Hypothermia published in Wilderness & Environmental Medicine 2014;25(4):425-445.

Managing accidental hypothermia: a UK-wide survey of prehospital and search and rescue providers

“…The potential risk of burns must also be considered, as the skin of hypothermic casualties is especially vulnerable. The heat packs should therefore not be placed immediately on to the skin8 and extra care taken when used in conjunction with supplemental oxygen 21…”

Role of Vascular Endothelial Cells in Disseminated Intravascular Coagulation Induced by Seawater Immersion in a Rat Trauma Model

“…Victims must face loneliness, fear, and a shortage of food and water. Additionally, victims usually develop hypothermia in cold water [15]. In some studies, the authors have suggested that hypothermia is the most important factor affecting the mortality of these victims [16].…”

“…No rat in the NS or control group died within 12 hours. It is important to note that “core temperature afterdrop” and “circumrescue collapse” can be caused by the sudden movement or removal of victims from the water following cold-water immersion [15, 22]. Therefore, the rectal temperature and other vital indicator observations were performed very carefully in the rats to avoid death due to man-made disturbances.…”

Comparison of Distal Limb Warming With Fluidotherapy and Warm Water Immersion for Mild Hypothermia Rewarming

“…3 Whole body warm water immersion is contraindicated as it increases the risk of cardiovascular collapse. 4 However, immersing only the distal extremities in 451C water safely decreased afterdrop and almost tripled the core rewarming rate to (9.91C Á h À1 ) compared with other external methods. 5 Limitations of this method include water spillage, specialized temperature control equipment, space requirements, and a fixed location.…”