New ‘Cold Card’ helps first-responders treat hypothermia

(Reuters Health) – Search and rescue teams and first responders have a new resource for assessing people who have been exposed to extreme cold.

Based on Wilderness Medical Society guidelines, the two-sided card provides practical advice and visuals that quickly explain how to evaluate someone with potential hypothermia.

“Although there are many people in wilderness medicine and search and rescue, hypothermia is a rare event for any given practitioner,” said Gordon Giesbrecht of the University of Manitoba in Winnipeg Canada, who created the card for doctors, paramedics and first responders to print and keep handy.

“When I gave a talk to the Ontario Association of Chiefs of Police, a guy asked if there was a card that summarized everything I had just taught,” Giesbrecht said in a phone interview. “I told him that the only thing wrong with that idea was that I hadn’t thought of it myself.”

The card is available for free on the Wilderness & Environmental Medicine journal website ( The front of the card explains how to evaluate a cold-exposed patient based on consciousness, movement, shivering and alertness. For instance, patients who are conscious, have normal movement, are shivering and alert are considered “cold stressed” and not hypothermic. They should remove wet clothing, add dry clothing, move around to warm up, and consume a high-calorie food or drink.

Those who are conscious, alert and shivering but showing impaired movement have mild hypothermia. They should be handled gently, insulated with a vapor barrier, provided heat around the upper trunk, given a high-calorie food or drink, monitored for at least 30 minutes and advised to sit or lie down for at least 30 minutes. If there’s no improvement after that period, they should be evacuated.

Moderate hypothermia includes a dramatic shift from shivering to not shivering and from alert to not alert, although still conscious. These patients should be kept horizontal, not allowed to stand or walk, and not advised to eat or drink. They should be insulated with a vapor barrier, given heat to the upper trunk and given a warm intravenous fluid. They should be evacuated from the area carefully.

In the worst cases, severe hypothermia occurs when someone is unconscious as a result of the cold. Typically, these patients are treated in the same way as moderate hypothermia cases. If there’s no breathing or pulse, CPR should be started immediately. In addition, these patients should be evacuated as soon as possible.

“Hypothermia is rare but it’s important for people to know about the signs and what to do,” Giesbrecht said.

The back of the card explains how to care for a cold patient, including how to do “The Burrito” hypothermia wrap. Search and response teams should carry several supplies when in cold environments, including a hooded sleeping bag, an insulated ground pad, a tarp or plastic sheet as a vapor barrier outside the sleeping bag, a plastic or foil sheet for a vapor barrier inside the sleeping bag, and a source of heat for each team member.

When creating “The Burrito,” patients with dry or damp clothing should leave their clothes on before being wrapped. With wet clothing, those who are less than 30 minutes away from transport and shelter can leave clothing on but must be wrapped immediately. For those who are more than 30 minutes away from shelter or transport, wet clothing should be removed before the patient is wrapped.

The tarp should be placed on the ground, followed by the ground pad, sleeping bag and foil. The patient should lie on the foil, and heat should be applied to the upper torso and armpit areas. The Cold Card then shows a visual for how to fold the foil, sleeping bag, ground pad and tarp around the patient to allow for a sealed moisture barrier but also space around the face for the patient to breathe.

“Treatments for hypothermia are based on core temperature, but in the field setting, that’s hard to measure,” said Dr. Colin Grissom of the Intermountain Medical Center in Murray, Utah. Grissom, who wasn’t involved creating the Cold Card, was part of the Wilderness Medical Society team that wrote the hypothermia guidelines on which the card is based.

“The simple visual layout shows an easy-to-understand way to assess a patient,” he told Reuters Health by phone. “This card would be helpful for a relatively inexperienced first responder or lay person who wants common understanding of how to treat cold-exposed people.”

SOURCE: Wilderness & Environmental Medicine, online October 8, 2018.

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