After the IFAK: Part II
Welcome to my soapbox. Hypothermia is an absolute killer yet when it comes to tactical medicine it is often mentioned, verbalized, and promptly forgotten. I’ve taught more than a few dozen medics and hundreds of regular infantrymen casualty assessments of different levels; many have blatantly forgot or ignored this step.
This is “After the IFAK,” so keep in mind that our scenario assumes that you’ve used one or a few items of someone’s trauma aid kit. The bleeding is controlled, and whether you’re waiting on a Blackhawk or a civilian ambulance, you’ll be sitting with that casualty for a while. In the last article we converted a tourniquet to allow for as much blood flow as possible. Now we keep the patient warm.
What is Hypothermia?
You probably already knew this but to put it simply, it is when you’re too cold. Clinically, it is defined as having a core body temperature below 95 F. Whenever someone is dealing with blood loss, they will experience hypothermia.
This is because your blood itself is one of the best temperature regulation systems in your body. In the event someone sustains a major bleed they will simultaneously be losing much of their body’s capability to keep itself warm. Since they can’t regulate their temperature, you’ll need to do it for them.
The Triad of Death
Why does it matter if your patient is a little cold? Shivering a bit shouldn’t be that important considering they just got shot, right? Wrong, as you probably guessed. The reason why is because of the Triad of Death.
The Triad of Death is a name that is a bit ominous, yet apt. You will notice that hypothermia is one of the corners of the triangle, along with two other medical terms of coagulopathy and metabolic acidosis.
To quickly summarize (and this is a grossly oversimplified) coagulopathy is the ability of your body to create blood clots naturally, and metabolic acidosis is an imbalance of the pH level of your blood.
This is a triad because they are all linked. In order to create clots your blood needs to be of the right pH and warm enough. If it doesn’t have the right pH, it will limit the ability of your body to regulate heat. If your blood is too cold, the pH will be off. It is a triangle because if you kicked in one leg, the whole thing would collapse.
Simply put, if your patient is too cold their body will not have the ability to create the natural internal clots you will rely on for long-term survival. The tourniquet and bandage you used did help with that process, but your patient will very likely have sustained internal damage that you cannot fix. And for these internal injuries to be helped you need to ensure that the patients’ internal clotting mechanisms continue to function.
In order to do that, you’ll have to keep them warm.
Keeping Casualties Warm
The first consideration is moisture. Moisture absorbs heat much quicker than anything around it, meaning that anything wet on your patient will be robbing them of warmth. Anything soaked with blood or sweat should be removed, these will only work against you.
Transfer through other materials will waste some heat and also take longer. Because of this, warming directly to the skin is the best method. You will often hear those adept in winter camping recommend you sleep in just a dry t-shirt and your underwear. This is because any heat caught by your sleeping bag will be most efficiently returned to you if there are no barriers between what is warm and your skin.
Placement is another consideration. It is better to have your patient in a warm place over a cold place. Do not place them in a building with the air conditioning cranked if it warm outside. Don’t place them in the shade when you have the sun. Place them closer to a campfire than further, etc.
Most importantly, continuously check on them. The rule of thumb in trauma medicine is at least every 5 minutes. When things turn, they do so quickly.
To burrito your patient is to ensure they are completely encompassed in a material intended to keep them warm. Illustrated above is a method taught to mountain climbers to wrap someone suffering from hypothermia in a blanket, sleeping bag, their camping pad, and then another blanket. This creates a layer of insulation around every portion of the patient.
This method can be employed whether you only have a single blanket, or an array of bugout or camping supplies. Simply ensure your patient is completely wrapped and tucked, leaving only a small window for their face so they can breathe.
I would emphasize creating additional layers between the patient and the cold ground and also ensuring they are wearing some sort of hat. When you lose blood, your body shunts what you have left to the core and the brain, making your head the most vulnerable place on a patient to lose heat.
There are many trauma related emergency blankets designed for such an occasion, but remembering that we are speaking about IFAK’s and improvised daily materials, I will not cover those in this article.
Alternative Warming Methods
The burrito is the most popular, but when it comes to improvised medicine we must keep our minds open. Here is a list of things to consider that may get the imagination rolling.
- Body heat (snuggle up with your battle buddy)
- The hood of a running car
- A campfire
- Place bottles of warm water around the neck and armpits
- Leaned up against an oven door
- Hand warmers
The list could be endless, just realize that you don’t need a dedicated trauma blanket in order to treat Hypothermia.
After the IFAK Part III: Wound Care
I hope there was something in this article that stuck with you that may come in handy in the unfortunate event that you should need it. In the next section we will talk about considerations for if you have to treat a buddy for more than 24 hours; Wound Care.