05 January 2010

Baby, It's cold outside....

Well it seems winter has set in and plans to stay for a while. The grass has reached the point where it looks as close to dead as one can imagine. The birds only appear sporadically for food and the battery in the truck sings it's pitiful woes every time I crank it.

It's been consistently in the low 30's for the past week or so now, and the weather man said this morning that we should expect it to be like this for at least another week. It's bitter and the wind cuts right through you. But I'm even more thankful that I don't live or work in the "coldest place in America"...International Falls, MN. They said the temperature there was a high of -37 degrees, and that's without the windchill.

So the bottom line is this; it's cold, and I can't think of a better time to talk about cold emergencies and how we can combat them in the field.

First before anything else is preparation, and I'm not even talking about equipment yet. Think about your demographic. Are most of your citizens elderly or do you have a certain percentage of people who may be having trouble paying for a heat source? Are there homeless in you area that are susceptible to the cold?

Knowing who will help greatly with the what. We know that with the weather in the extremes it doesn't take long for hypothermia to set in especially to those who brave the cold with exposed skin or little clothing. According to the experts, life threatening hypothermia can occur in an average size male, who is not performing any activity, in as little as an hour.

You knew it was coming; scenario time....You're called to a scene where PD is out with a male subject behind a shopping center in the wee morning hours, he is lethargic but responsive to interview. You notice that he is disheveled and notice several bottles of what used to contain alcohol strewn about. Assessment reveals some significant findings; B/P(-), P(-), SCT(-), BG(+/-80), SpO2(+/-94), EKG(SR@58). Your patient says he had a run of bad luck, lost his job and has been on the streets for a week now; no family and no where to go. Your community has no outreach programs available.

How are you going to treat this patient? Does he require treatment beyond what you can provide? Do you warm him up and just send him back out into the cold or do you start active rewarming and transport hoping to at least get him out of the weather for the night? Now this is just some food for thought. No pass or fail.

We as providers need to be ready to deal with these very real scenarios. Our trucks and equipment should not contribute to an already bad situation. Suppose an elderly lady has slipped on some ice and is not able to move due to the pain. You show up 20mins. later with a truck that is barely warm, put her on a cold backboard or scoop stretcher and then on a cold cot. What have we done to her situation? She's uncomfortable as it is due to the pain and cold due to short-term exposure and we have just made it worse. Imagine if it were the guy above and he was totally unresponsive and we done this to him; did we make it better or just continue his environment to a lesser degree?

We as pre-hospital providers need to be aware of all the different ways that our actions and our environment can effect the patient. Sometimes we're not able to offer a warm cot or backboard, so carry an extra couple of blankets just in case you need to wrap a patient up to provide a barrier against a cold cot or board.

For those severe cases where active warming is necessary, keep a bag of saline solution wrapped in a heating pad on a low or medium setting. Or just have the heating pad ready and wrap the line around the pad several times to allow the fluid to warm a little before entering the body. Just remember, normal body tempature is around 98.6 degrees, so even room tempature fluids are not doing any good at this point. If your on post or at a station without a heated bay, you may have to get creative with your treatment, but ultimately it is up to you to provide a pleasant environment and care on those cold and blustery days.

Stay warm my friends!

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