Frequently Asked Questions About Heat Illness & **Understanding Hypothermia:** & **Understanding Frostbite:** & Step-by-Step Emergency Response Instructions & **For Hypothermia:** & **For Frostbite:** & **Critical Mistakes:** & **Dangerous Treatment Myths:** & **Call 911/Evacuate Immediately For:** & **Can Provide Field Treatment If:** & **Cold Water Immersion:** & **Elderly and Cold:** & **Urban Cold Emergencies:** & **Scenario 2: Found Down Elderly** & 8. Consider helicopter evacuation

Q: Can you get heat stroke on a cloudy day?

A: Yes. High humidity, physical exertion, and certain medications can cause heat stroke even in moderate temperatures. Cloud cover doesn't eliminate risk, especially during exercise.

Q: Why do some people with heat stroke still sweat?

A: Exertional heat stroke (during exercise) often includes continued sweating. Classic heat stroke (gradual onset) typically features dry skin. Both are medical emergencies requiring immediate cooling.

Q: How quickly should body temperature drop during cooling?

A: Aim for 1-2°F every 5 minutes initially. The goal is reaching 102°F within 30 minutes. Aggressive cooling is crucial—you cannot cool too fast in true heat stroke.

Q: Can I give salt tablets for heat cramps?

A: No. Salt tablets can worsen dehydration and cause nausea. Use balanced sports drinks or salty snacks with water. Most people get adequate salt from normal diet.

Q: How long does recovery take?

A: Heat exhaustion: 24-48 hours with rest. Heat stroke: Days to weeks, sometimes with permanent organ damage. Some people remain heat-sensitive indefinitely after heat stroke.

Q: Should I use rubbing alcohol to cool someone?

A: No. While alcohol evaporates quickly, it can cause shivering (generating heat) and be absorbed through skin. Use water—it's safer and more effective.

Q: Is it true you shouldn't drink ice water when overheated?

A: This is a myth. Cold fluids help cool core temperature. The key is drinking slowly to avoid stomach cramps. For heat stroke, external cooling is more important than drinking.

Q: Can air conditioning prevent heat illness?

A: Yes, dramatically. Even a few hours in AC daily during heat waves significantly reduces risk. Libraries, malls, and movie theaters provide public cooling options.

Q: What's the difference between sunstroke and heat stroke?

A: They're the same condition. "Sunstroke" is an older term. Heat stroke can occur without sun exposure—in hot factories, vehicles, or during indoor exercise in heat.

Q: When can someone return to activities after heat illness?

A: Heat exhaustion: Wait at least 24-48 hours. Heat stroke: Requires medical clearance and gradual return over 1-2 weeks. Previous heat illness increases future risk permanently.

> Final Quick Reference Box: > Remember: C.O.O.L. for Heat Emergencies > - Call 911 for confusion or temp >104°F > - Out of heat immediately > - Off with excess clothing > - Liquid cooling aggressively > > Heat Stroke = C.A.M. > - Confusion/altered mental state > - Above 104°F temperature > - Medical emergency requiring 911

Final Critical Reminders:

Heat stroke is a true medical emergency where minutes count. The difference between heat exhaustion and heat stroke isn't just academic—it determines whether someone needs rest and fluids versus aggressive cooling to save their life. Mental status changes are the key differentiator. When in doubt, treat aggressively and call 911. Remember: you cannot cool someone too fast in true heat stroke, but you can cool them too slowly. Prevention through hydration, rest breaks, and recognizing early symptoms remains the best strategy. In our warming world, these skills are becoming increasingly essential for everyone to know.# Chapter 13: Hypothermia and Frostbite: Cold Weather Emergency First Aid

The rescue team found the hikers just in time. What started as a beautiful autumn day hike in the mountains had turned deadly when an unexpected storm brought freezing rain and 40-mph winds. The temperature dropped 30 degrees in two hours. When found, both hikers were severely hypothermic—one was unconscious with a core temperature of 82°F, while the other was confused, stumbling, and insisted he was "burning up" despite violent shivering. Their cotton clothing was soaked through, and both showed signs of frostbite on their fingers and toes. The rescue team's careful rewarming protocols over the next six hours saved their lives, though one hiker lost two toes to severe frostbite. Cold kills twice as many Americans annually as heat—over 1,300 deaths per year—yet many people underestimate its danger. Hypothermia can occur in temperatures as high as 50°F, especially when combined with wind and wet conditions. Unlike heat illness, which develops over hours, severe hypothermia can incapacitate someone in minutes in cold water. Understanding how to recognize, prevent, and treat cold-related emergencies is essential knowledge for anyone who ventures outdoors or lives in cold climates. The margin between a close call and tragedy often comes down to quick recognition and proper first aid.

Cold-related injuries affect the body both systemically (hypothermia) and locally (frostbite). Understanding the progression of each is crucial for proper treatment.

Mild Hypothermia (90-95°F core temperature):

- Shivering (body's attempt to warm itself) - Impaired judgment - Clumsiness or lack of coordination - Apathy or listlessness - Cold, pale skin - Quick breathing - Fatigue

Moderate Hypothermia (82-90°F):

- Violent shivering stops - Muscle stiffness - Slurred speech - Paradoxical undressing - Confusion and poor decision-making - Slow, shallow breathing - Weak pulse

Severe Hypothermia (Below 82°F):

- Unconsciousness - Cardiac arrhythmias - Barely detectable pulse - No apparent breathing - Rigid muscles - Dilated pupils - Appears dead

1. Stumbles - Loss of coordination 2. Mumbles - Slurred speech 3. Fumbles - Loss of fine motor control 4. Grumbles - Personality changes

> Quick Reference Box: > - Death possible below 70°F core temperature > - Shivering stops around 86°F > - Confusion begins around 91°F > - Water conducts heat 25x faster than air > - 50/50/50 Rule: 50°F water + 50 yards = 50% chance of drowning

First-Degree (Superficial):

- Skin is red and painful - Numbness and tingling - No permanent damage - "Frostnip" stage - Affects outer skin only

Second-Degree:

- Blisters form 24-48 hours later - Skin appears red and swollen - May have permanent nerve damage - Hard or waxy appearance - Affects outer and some underlying skin

Third-Degree:

- Deep frostbite - Affects all skin layers and tissue below - Skin appears white, blotchy, and/or blue - Area is hard and numb - Joint or muscle involvement

Fourth-Degree:

- Affects muscles and bones - Area appears black and hard - Extremely high risk of amputation - Often combined with hypothermia - Permanent damage certain

- Fingers and toes (90% of cases) - Nose - Ears - Cheeks - Chin - Any exposed skin in severe conditions

Environmental:

- Temperature below 32°F - Wind chill factor - Wet conditions - High altitude - Duration of exposure

Personal:

- Inadequate clothing - Wet clothing - Tight clothing/boots - Previous cold injury - Poor circulation - Alcohol or drug use - Dehydration - Fatigue

Proper treatment of cold emergencies requires careful handling to prevent further injury and cardiac complications.

Step 1: Assess and Call for Help

- Check responsiveness carefully - Call 911 for moderate/severe cases - Handle extremely gently - Check pulse for full 60 seconds - Cold hearts are irritable

Step 2: Prevent Further Heat Loss

- Move to shelter if possible - If not, create windbreak - Remove wet clothing by cutting - Insulate from ground - Cover with blankets/sleeping bags

Step 3: Begin Rewarming (Mild Cases Only)

- Warm center of body first - Use body-to-body contact - Warm, sweet drinks if fully alert - No alcohol or caffeine - Chemical heat packs to torso

Step 4: Monitor Carefully

- Handle very gently - No rubbing or massage - Watch for afterdrop - Be ready for cardiac arrest - Document improvements

Step 5: Advanced Considerations

- If no pulse after 60 seconds, begin CPR - Continue CPR longer than normal - "Not dead until warm and dead" - Only medical professionals should pronounce death - Many "miraculous" recoveries documented

Critical: Prevent Cardiac Arrest

- NO active rewarming in field - NO rubbing or massage - NO hot water or direct heat - Handle like spinal injury - Horizontal position only

Field Treatment:

> Practice This Now: > - Practice 60-second pulse checks > - Set up hypothermia wrap system > - Locate chemical heat packs > - Practice gentle handling > - Review CPR in cold conditions

Step 1: Protect the Area

- Don't walk on frostbitten feet unless necessary - Protect from further freezing - Handle extremely gently - Remove jewelry/constrictive items - Don't smoke (reduces circulation)

Step 2: Assess Severity

- First-degree: Rewarm on site - Second-degree or worse: Medical care - If hypothermic too: Treat that first - Document affected areas - Take photos if possible

Step 3: Field Treatment

- Protect from refreezing - Don't rub or massage - Don't use direct heat - Skin-to-skin warming for minor cases - Loose, dry bandaging

Step 4: If Medical Care Delayed (>2 hours)

- Rapid rewarming in 98-102°F water - Immerse for 15-30 minutes - Severe pain is normal - Give pain medication - Protect thawed tissue

Step 5: After Rewarming

- Apply loose, dry dressings - Separate affected digits - Elevate if possible - Give pain medication - Prevent refreezing at all costs

1. Vapor barrier (plastic) against skin 2. Insulation layers (sleeping bags/blankets) 3. Heat sources at trunk only 4. Wind/water protection outer layer 5. Leave face exposed for monitoring

Many traditional cold weather treatments can actually cause more harm. Understanding what NOT to do is crucial.

1. Rubbing Frostbitten Areas

- Ice crystals damage cells like glass - Rubbing causes more tissue damage - Can break blisters - Increases infection risk - Gentle handling only

2. Using Direct Heat

- Hot water burns numb tissue - Fires can cause burns - Heating pads dangerous - Car heaters too hot - Gradual rewarming safer

3. Giving Alcohol

- Vasodilation increases heat loss - Impairs shivering - Affects judgment - Dehydrates - Can trigger cardiac issues

4. Walking on Thawed Feet

- Causes severe tissue damage - Better to walk on frozen feet to safety - Once thawed, no weight bearing - Refreezing catastrophic - Evacuation required

| DO | DON'T | |---|---| | Handle hypothermic patients gently | Rub or massage cold skin | | Rewarm gradually | Use direct heat sources | | Insulate entire body | Focus only on extremities | | Give warm, sweet drinks if alert | Give alcohol or caffeine | | Check pulse for 60 seconds | Assume death in cold patient | | Protect from wind/wet | Leave in wet clothes | | Warm core first | Warm extremities first | | Continue CPR until warm | Stop CPR in cold patient |

"Rub Snow on Frostbite"

- Causes more tissue damage - Old wives' tale - Ice crystals act like glass - Increases injury - Never use snow/ice

"Alcohol Warms You Up"

- Actually increases heat loss - Dilates surface blood vessels - Impairs judgment - Prevents shivering - Potentially fatal mistake

"Put Them in Hot Bath"

- Can trigger cardiac arrest - Afterdrop phenomenon - Burns numb tissue - Too rapid rewarming - Gradual is safer

Cold emergencies often occur in remote locations, making the decision about evacuation versus field treatment critical.

Any Moderate/Severe Hypothermia:

- Core temp below 90°F - Shivering stopped - Confusion or altered mental state - Decreased consciousness - Slow or irregular pulse

Frostbite Requiring Evacuation:

- Any second-degree or deeper - Multiple digits affected - Face involvement - If refreezing likely - Combined with hypothermia

Environmental Factors:

- Continued exposure likely - Weather worsening - Darkness approaching - Injured person can't self-evacuate - Multiple victims

Mild Hypothermia Only:

- Still shivering - Alert and oriented - Can generate own heat - Shelter available - Improvement with treatment

Minor Frostbite (First-Degree):

- Small area affected - No blisters - Can prevent refreezing - Pain manageable - Medical care within hours

> Important Disclaimer: > Cold emergencies can deteriorate rapidly. Severe hypothermia requires extremely careful handling to prevent cardiac arrest. The decision to rewarm frostbite in the field depends on preventing refreezing. When in doubt, evacuate for professional medical care. This guide cannot replace wilderness first aid training for backcountry activities.

1. Immediate: Unconscious, no shivering, severe frostbite 2. Urgent: Confused, moderate symptoms, facial frostbite 3. Soon: Mild symptoms not improving, risk of worsening 4. Monitor: Mild symptoms improving with treatment

Different scenarios and populations require modified approaches to cold injury management.

Immediate Threats:

- Cold shock response (1 minute) - Swimming failure (10 minutes) - Hypothermia (30 minutes) - Post-rescue collapse

1-10-1 Principle:

- 1 minute to control breathing - 10 minutes of meaningful movement - 1 hour before unconsciousness

Rescue Considerations:

- Horizontal removal vital - Cardiac arrest risk high - Continue CPR longer - Submersion doesn't mean death - "Diving reflex" in children

Higher Risk Because:

- Larger surface area to mass ratio - Less subcutaneous fat - May not recognize danger - Can't generate heat as well - Dependent on adults

Special Considerations:

- Hypothermia develops faster - May have "miraculous" recoveries - Don't give up resuscitation - Diving reflex stronger - Keep searching in cold water

Increased Vulnerability:

- Decreased ability to sense cold - Medications affect thermoregulation - Less muscle mass for shivering - Often found indoors - Social isolation

Indoor Hypothermia:

- Common in elderly - Room temperature 60-65°F - Develops over days - Often missed - High mortality

Triple Threat:

- Asphyxiation - Trauma - Hypothermia

Survival Statistics:

- 15 minutes: 92% survival if airway clear - 35 minutes: 30% survival - 90 minutes: Near zero without air pocket

Treatment Priorities:

Homeless Population:

- Chronic cold exposure - Multiple medical issues - Substance abuse common - Delayed presentation - Need social services

Carbon Monoxide Risk:

- Space heaters - Running cars for warmth - Blocked vents - Combined with hypothermia - Check for CO exposure

Regular practice improves recognition and treatment skills. Work through these scenarios mentally.

Your friend falls through ice while fishing. You pull him out after 5 minutes. He's conscious but shivering violently and having trouble speaking.

Your Actions:

Key Points:

- Rapid cooling in water - High risk of afterdrop - Need immediate evacuation

You find your elderly neighbor on her porch in 40°F weather. She's confused, not shivering, and doesn't know how long she's been outside.

Your Actions:

Critical Recognition:

- No shivering = moderate/severe - Elderly high risk - Gentle handling crucial

During a winter hike, your partner complains of numb toes. You're 3 hours from the trailhead. His toes are white and hard.

Your Actions:

Important Decisions:

- Don't thaw in field if refreezing possible - Walking on frozen feet less damaging than thaw/refreeze - Speed crucial

> Practice This Now: > Cold weather preparation drills: > - Build hypothermia wrap > - Practice gentle patient movement > - Check outdoor gear adequacy > - Review evacuation routes > - Test emergency communications