Red
Rose Cave and Pothole Club - Newsletter Vol. 6 No. 5 - October 1969
First Aid for Cavers - Part 2.
Treatment for Cold Exposure.
‘Exposure’ or hypothermia is a fall in body temperature due to
loss of heat to the environment. On all major cave trips especially when one is
wet it is 1ikely to be developing to some degree whenever
the body heat reduction from muscular activity, falls below a certain
critical level When one is immobilized through injury heat loss will rapidly
exceed heat production and the body temperature will tend to fall.
Thus protection from exposure must be considered in the treatment of
all caving casualties, It develops insidiously and signs of
its onset can include shivering, feeling cold, fatigue, unreasonable
behavior lethargy, confusion, violent trembling attacks, slurring of
speech, muscular weakness, inability to walk, lack of co-ordination pallor
cramps etc. etc ....
At times individuals developing exposure can be awkward, non
co-operative and even show short burst of extreme undirected
activity. On long cold trips leaders should be aware of the significance
of the above features. It is more likely to develop in the thinner less
well clad and less experienced members of the party.
The additional factor of physical exhaustion over and above cold is
especially perilous and hunger will also worsen the situation. As the central or core’ temperature falls
then drowsiness gives way to unconsciousness, coma and then within
perhaps less than one hour death. Obviously neglect of patients
with symptoms of exposure can have serious consequences. What does
one do if this condition develops underground? The most likely and
serious mistake would be for well meaning colleagues to force the patient
to move out of the cave under his own steam when he
is not fit to do so and thus add the further dangerous insult of
exhaustion to his core body. However, having said this it becomes
apparent that the leader has then to take the difficult decision of
whether to delay completely his removal from the cave until a
rescue teem with blankets and stretcher arrives,
which may be several hours or whether to attempt to move the victim
with available resources and risk worsening his patient through exhaustion. The
decision must depend on the particular circumstances but in milder cases
able to move under their own steam, before getting him out of the system
one should try to improve the victims condition with the
following measures aimed at preventing further heat loss by insulation,
1. Make him rest in the driest and most sheltered spot
available. .
2. Wring out very wet top clothing and also put on
other clothing borrowed from fitter (and fatter) party members. If he has no
wet suit, putting him into of these will provide a lot of extra insulation, but if possible fit it over existing clothing to avoid chilling him further by complete undressing. .
3 Feed him if any nourishment (especially sweet) is available.
Hot drinks are beneficial but alcohol is most detrimental as skin blood
vessels become opened
up, allowing further heat loss.
.
4. Insulate him by having several members of the party lying in close contact with him and any spare clothing put underneath and or on him. A bed of ropes provides a considerable degree
of insulation. If
a 'spare blanket’ is
available wrap him in this to minimize further heat loss. If the patient is very cold and thus not losing heat excessively the benefits of this technique will be less and theoretically one could argue that he should be wrapped in a space blanket together with a
warmer colleague, if practicable. If
a sleeping bag is
available he should be
put in this, again possibly together with a, warmer colleague. If
this is other than a
mild case of exposure in an
accessible pot this is the time for a C.R.0. cal1 out, not when he is obviously
deteriorating. In other than mild cases, medical aid should be sought. If these measures produce an improvement then it is reasonable
to attempt to help the victim to get out of the system on his feet. Again however it must be stressed that if he is worsening then one must avoid forcing a tiring man to progress and be made worse by exhaustion and fatigue. Make him rest again
and support him with
the measures outline above.,
The stretcher party on arrival will be able to provide further insulation
and should start movement to the surface with minimal delay. At
this stage the problem arises as
to whether one should strip a cold wet caver underground to put him into a dry exposure bag or whether one should
put him in as he is whereby avoiding the initial further chilling, but remain wet. Again the decision must be an individual one. in practice the clothing nearest to the body will probably have reached skin
temperature any-way and it’s
removal will cause further loss of heat. Also if he is going to get wet on the way out, as is likely, it would seem unwise
to remove a wet suit
The context of core temperature is worth mentioning., The body will exercise considerable ingenuity in maintaining the temperature of the blood perfusing the vital central organs principally
the heart and brain. To this effect the circulation to the skin
and extremities will be
almost cut off and these parts become very much colder then the vital
body core. Where a fall in temperature
would be rapidly fatal.
During re-heating there is the
risk that if parts
of the cold body surface
are warmed locally, as with hot
water bottles on the limbs,
then a considerable amount of
cooled blood in the previously shut down circulation of those limbs may rapidly re-circulate back
to the body core causing a
disastrous fall in the temperature there. This is a very real risk and death during the warming up period has occurred all too often. To avoid this risk one re-warms a patient either:- .
a). Very slowly by providing only insulation with blankets etc. and not extreme heat, This
may take 48-72 hours, for normal body temperature to be reached. .
b) Very rapidly by immersion
in warm water the temperature of which must be maintained as
it is cooled by the
patient. This latter method
introduced in recent years by R.A.F. mountain rescue medical personnel has proved life saving
in dealing with cold exposure cases and gained
universal acceptance. The
whole body surface is re-warmed
rapidly so that the static cooled blood in the skin and extremities is raised to body temperature as fast as it
is diverted back into the general circulation so that the core temperature is maintained.
The technique is as follows:-
.
After quickly removing outer clothing (under clothing can be removed under water)
the victim is immersed
to the neck in a bath of hot water
at 45 degrees
cent. or 112 degrees f.. A
Thermometer should be used to check the bath temperature ,but if this is not available, judge the
bath temperature as the hottest
in which an immersed elbow can be kept. Beware of the
patient splashing violently when first immersed. Try to keep him immersed to the
neck when re-warming. Keep him in the bath until he begins to sweat visibly
on the face, which shows that body temperature has returned to
normal. Maintain the bath temperature at 43 to 45 c
or 108 to 112 f. by the adding of further hot water ( this is most
important). If an incident occurs near to Bull Pot Farm, members should
switch on the immersion heater immediately and refrain from
drawing hot water and heat extra water in pans etc in case it is
the form of treatment is necessary. One final word of warning. If
cold exposure develops in one member of a party be ready for
its onset amongst his colleagues on the trip.
Dr. John C. Frankland.