EMS Encouraged to Learn Characteristics of Hypothermia

Doctors in the Emergency Department at The Ohio State University Wexner Medical Center have
formalized the process for treating hypothermic patients.

“Hypothermia occurs when the body loses heat faster than it can produce it, often resulting in
dangerously low body temperatures,” Colin Kaide, MD, associate professor of Emergency Medicine at
Ohio State Wexner Medical Center, said. “Once a person’s core body temperature falls below 95 °F, we
consider them hypothermic.”

Hypothermia is categorized into three stages: mild, moderate and severe. Each stage is determined by
body temperature and key common symptoms, such as level of consciousness, shivering intensity and
cardiac rhythm.

Shivering occurs in mild hypothermia when the body temperature is 95-90 °F. A patient with mild
hypothermia should be rewarmed with blankets. If possible, they should be given warm fluids
intravenously and warm air to breathe.

The absence of shivering indicates that the body temperature has fallen below 90 °F and the condition
has progressed to moderate hypothermia. Symptoms will worsen as the body temperature declines,
leading to severe hypothermia.

“Alert patients with mild hypothermia can be treated in the field, while patients with moderate and
severe hypothermia should be transported to the hospital,” Dr. Kaide explained.

During transport, it is recommended to keep the patient horizontal, remove wet clothing, insulate them
in warm blankets and turn up the heat in the vehicle. If possible, provide warm IV fluids and warm air to
breathe.

There are also three situations in which a patient can be found with hypothermia. In the first situation, a
person is found down and is too weak to produce energy, leading their body to assume the
environment’s temperature. This situation is often associated with older patients who have fallen and
have not been able to get up for an extended period of time.

“EMS personnel should pay attention to the body temperature of anyone who is found down,” Dr. Kaide
said. “People who are found down and cold can look and seem dead. They may have a slow heart rate,
shallow respirations and no pupillary response, but they may be revived if they are treated for
hypothermia.”

The second situation is environmental exposure to cold weather. This is especially dangerous for
someone who has been found unconscious or has been drinking. Alcohol causes the blood vessels to
dilate, which increases blood flow and accelerates the process of heat loss.

The third situation involves water submersion. Water is more efficient at transferring heat; therefore,
exposure to 50 °F water can lead to profound hypothermia.
“The Rule of 50s says that on average, 50 percent of the people who are exposed to 50 °F water will die
of hypothermia in only 50 minutes,” Dr. Kaide said.

The advice for EMS personnel is to be aware of and recognize the characteristics of hypothermia in
patients.

“If you think hypothermia is a possibility, tell the treatment team,” Dr. Kaide said. “Communicate the
circumstances, down times and symptoms. Your thoroughness may help save a life.”