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How to avoid, recognize and treat Hypothermia:

PREPARE FOR THE WORST BEFORE SETTING OUT IN THE WINTER

PREPARE FOR THE WORST BEFORE SETTING OUT IN THE WINTER
Op-Ed By Bob Speik
Bulletin Guest Columnist
Published on November 28, 2010
The Sunday Bulletin’s Fall/Winter High Desert Pulse article "Surviving the cold" by reporter Briana Hostbjor, might be helpful for some but it misses a good opportunity to give novice to advanced hikers, snowshoers, skiers, hunters, snowmobilers, climbers and other outdoor folks, facts they need to mitigate the inherent risk of hypothermia during outdoor winter adventures.

Ms. Hostbjor advises us to 1. Avoid severe cold if you are able, wear layers and a hat, drink warm liquids, “and have access to a shelter or know how to make in case you become stranded outdoors”. Travel in groups so you can help each other and share body heat. 2. Stay dry and remove wet clothes as soon as possible. 3. Don’t wear cotton! Wear wool or fleece. “And if you have an outer shell that repels water and can keep you dry, all the better.” 4. Avoid alcohol and 5. Help the young and old.

Three large illustrations show a man wearing a heavy shirt and big heavy jacket, wide open at the neck, and a big hat and mittens. The text in the illustrations features the Fahrenheit core temperature of individuals with mild, moderate and severe hypothermia, of clinical interest to medical personnel with thermometers. The statement, ”If you’re stuck outdoors, curl into a ball, sitting upright”, is bad advice, read below. This Pulse article misses an opportunity to provide informed, practical information for Bulletin readers who venture into the outdoors in winter.

Avoiding hypothermia on a winter’s day adventure starts with a trip plan.

Base your trip plan on your study of a good map, for a snowshoe walk, a hunt, or a climb to a summit, all best done with companions. Carry a $7.00 USGS topo map, a $30.00 base plate compass adjusted for 16 degrees declination and perhaps a simple current $99.00 GPS receiver, now accurate to 4.1 meters.

Next in importance is a weather dependent collection of personal clothing layers.

Wear synthetic base-layer underwear that wicks moisture, mid-layers of insulating Polypro and pile that do not absorb moisture and an absolutely essential waterproof-breathable jacket-and-pants for rain, snow and wind protection. (Non-breathable rain gear almost ensures heavy sweating with dehydration and wetness.)

The purpose of having clothing “layers” is to prevent base and mid layers from becoming sweat-soaked when very active, by removing insulating layers. Cotton clothing, wet from absorbed sweat, rain, snow, foliage, etc. can induce hypothermia by the efficient cold conduction by water from even 50 degree air.

Each person must wear and carry the best clothing system needed for the forecast weather. Carry various hat and glove layers, not just your big woolly hat and mittens. Stuff your puffy down jacket into your light day-pack. It will help insulate you at lunch stops and through the night.

The onset on hypothermia in a companion is unmistakable to an informed observer.

The moment your body losses essential heat faster than it is producing heat, you will begin to shiver involuntarily and your body will begin to shut down blood flow to your extremities to maintain temperature in its core. You will begin to lose control of your hands, motor skills and reasoning. You will have the “Umbles” - you will mumble, grumble, stumble, tumble, fumble and bumble.

Immediate action needs to be taken by your group.

Slow down or stop! Body heat is lost at a high rate from heavy breathing. Don’t permit yourselves to sweat. Don’t exhaust your limited glycogen reserves. Trying to find your way or reach an unrealistic destination can be a fatal error.

Starting a fire in a snow storm is generally impossible; “sheltering” in the snow requires special skills, insulating pads and snow shovels.

You body produces heat from digesting food and from muscle contractions including uncontrollable shivering. Do not “curl up into a ball, sitting upright”. Exercise vigorously in place, eat and drink.

Here is how to “Be Prepared”.

You must plan for the unexpected. Each person should dress for the forecast weather and carry extra clothing layers for protection from a drop in temperature and possible rain or snow storm or an unexpected cold wet night out, an insulating pad for the wet ground or snow, high carbohydrate snack food, two quarts of water or Gatorade, a map, compass and inexpensive GPS and the skills to use them together. Carry the traditional "Ten Essential Systems" in a day-pack, five pounds in summer, sized for the season and the forecast weather.

Tell a Responsible Person where you are going, where you plan to park, when you will return and make sure that person will call 911 at the time you specified. Carry your common digital cell phone, as well.
If you become injured, lost or stranded, talk with 911 immediately, don't wait until nightfall and you are desperate.

Help take the ‘search’ out of search and rescue. SAR’s volunteer services are free in Oregon!
Copyright©, 2010-2011 by Robert Speik. All Rights Reserved.

Robert Speik lives in Bend and writes for his website, www.TraditionalMountaineering.org

Q. How can I prevent hypothermia?
1. Preventing hypothermia on a Spring, Fall or Winter’s day adventure starts with a trip plan and the ability to call for help if required:
Base your trip plan on your study of a good topo map, for a snowshoe walk, a hunt, or a climb to a summit, all best done with companions. Carry a $7.00 USGS topo map, a $30.00 base plate compass adjusted for 16 degrees East declination (in Central Oregon) and perhaps a simple current $99.00 GPS receiver like the Garmin eTrex H, now accurate to just 4.1 meters!   Five Basic Responsibilities
Learn to use map, compass and GPS, together!   Best maps   Best compass   Best GPS  

Carry an ordinary digital cell phone from a Provider which best covers the backcountry and an optional SPOT 2 GPS Satellite Messenger. Have a Responsible Person who knows you and your plan, who will call 911 if you do not return by an agreed time. Each member of your group should carry their ordinary digital cell phone in a pants pocket, turned off unless an emergency should take place.
What is the best cell phone for the backcountry?   SPOT 2 Satellite GPS Messenger

2. Next in importance is a weather and trip dependent collection of personal clothing layers, carried by each participant in a light day pack, three pounds in summer, a little more in winter.
What do you carry in your winter day pack?

We produce body heat in one major way: by the contraction of our large muscles.
We can control our production of heat and sweat by adjusting our pace and elevation gain, limited by the capacity of the least able in the group. If we are unable to exercise because we are exhausted, or injured or stranded in one place because we are lost or it is a very dark night or we must care for an injured companion, and we are sweaty and tired, we are in danger of becoming hypothermic, even in 50 degree weather!

We avoid becoming cold in any weather, by controlling the production of heat and the loss of body heat with special clothing, properly used.

Heat is lost in five simple ways:
1. Conduction: Heat loss from direct contact between a warm body and with a cold one, i.e. sitting or lying on the snow without an insulating pad.
2. Convection: Heat lost to moving air or water, i.e. the wind strips heat from you, i.e. the cold find goes right through my sweater.
3. Evaporation: Heat lost from the evaporation of water from your skin, i.e. an evaporative cooler, i.e. my clothes are drying but I am freezing cold.
4. Respiration: Heat lost in the process of breathing in cold air and exhaling warm moist air, i.e. I must breathe through my wool scarf.
5. Radiation: Heat is lost by the radiation of warmth to the cold air i.e. when I stop hiking, I get really cold. Wear hats and gloves and change them with the weather and exertion.

We wear special synthetic clothing layers chosen for the forecast weather and the specific adventure and carry extra clothing for a change in the weather and/or a forced overnight stop:
Synthetic clothing fibers are adsorbent: synthetic fibers like polypropylene, fleece and pile do not absorb water. Cotton clothing fibers can absorb up to 70 times their weight in water! Wet clothing conducts cold 25 times faster than still air!
a. We wear a non-cotton, wicking, loosely fitting, light and thin Capeline or polypropylene base layer.
b. We add or remove insulating, loose-fitting mid-layers.
c. As necessary, we add a top and bottom wind proof and/or windproof/waterproof/breathable outer layer.

We add or remove layers to adjust the venting of excess body heat to avoid sweat-wetness during strenuous exercise and to protect us from the wetness of rain, and snow and the cooling effect of wind. The layers must be loose to ease friction and allow air to circulate. What do you wear for a backcountry adventure in the winter?

We must stay dry:
We guard against loss of heat by the evaporation of water and sweat. Wind refrigerates (sweat or rain) wet skin or clothing by evaporating the moisture! We don an outer layer of jacket and pants constructed of modern waterproof-breathable fabric such as Gore-Tex. We avoid the cooling effect of wind by donning outer layers. Some polypropylene garments are designed to be wind resistant, perhaps at speeds up to 30 mph.

We must avoid exhaustion. Do not go at a speed beyond the capacity of your least capable companion. Try not to sweat. If forced to stop exercising, we may be moments from violent, incapacitating shivering, loss of judgment and the use of our hands. We must shelter from the wind, make a bivouac or return to camp before we lose the ability to do so.

3. A third important way to avoid hypothermia is by eating and drinking knowledgably.
As we hike and climb, we must eat simple carbohydrates (such as ClifBars) and we must stay hydrated.
To refuel our muscle fuel as we hike and climb hard, we must snack hourly, on easily digested convenient foods that are high in carbohydrates (sugar) and low in fat and with moderate protean. ClifBars meet this requirement. Endurance athletes know that our human muscles burn 30% glycogen to help our bodies efficiently burn fat, our main muscle fuel. Muscles "burn" fat (70%), with stored glycogen, in the presence of Oxygen (hiking at an aerobic pace, talking and not gasping for breath). Fat is stored in almost infinite amounts, easily seen on some of us; Glycogen is stored in finite amounts, unseen inside our muscles.
What should we know about "Carboration and Hydration" in aerobic mountaineering?

Jerky is primarily protein and salt, and despite popular folklore, has no place in the Essentials. Ask any track coach what you should eat before and during aerobic exercise.

However, when we shelter we can benefit from ingesting fatty foods such as GORP, because the more difficult chemical digestion of fats can help warm our bodies. GORP

We must drink water (with the high carbohydrate snack food, every hour) to keep our blood thin and circulating properly. If you allow yourself to become dehydrated, your thickened blood can not circulate as efficiently to your fingers, nose and toes.

If you eat without drinking water with the food, fluid will be drawn from your blood and sent to your stomach to liquefy the food so it can be sent where it is needed by the blood stream.

Keep your water from freezing by carrying it in a Nalgene or Platypus bag, inside your clothing. Carry a small hiking stove, pot and fuel in your winter essentials. (This can be Group gear. Hide it in your buddy's pack?)

If we know how, we can avoid hypothermia!

Q. How can I recognize hypothermia?
The onset on hypothermia in a companion is unmistakable to an informed observer. Watch yourself and others for the following overt symptoms:

The "UMBLES":
The moment your companion's body losses essential heat faster than it is producing heat, he will begin to shiver involuntarily and his body will begin to shut down blood flow to his extremities to maintain temperature in its core. He will begin to lose control of his hands, motor skills and reasoning. He will have the “UMBLES” - he will mumble, grumble, stumble, tumble, fumble and bumble. He may be careless in his dress against the cold and wind, he may drop a glove or a hat. (Don't be shy! A group I was training 30 years ago, allowed me to display all the symptoms and almost collapse in the snow before they asked if I was OK. They were shocked when I came back from the "dead" and chewed them out!)

You may become unable to recognize these symptoms in your self!
Appoint a foul-weather leader whose job is to think about the dangers of this insidious problem for outdoor recreationists. This person might be the best-protected, strongest, most experienced member of the group, an Assistant Leader, responsible for calling a halt before the least protected member of the group becomes uncoordinated or exhausted or begins violent shivering.

Q. How can I treat hypothermia?
Immediate action needs to be taken by your group. Stop! Trying to find your way in a storm or dark of night or reach an unrealistic destination can be a fatal error.
Climbing together    Following the Leader

If you know your reasonable way back to camp or car using your map, compass and GPS together, stop for a few minutes.
Get the hypothermic companion, as best you can, into more dry clothes, from his day pack or from companion's extra layers. If he can talk with you, give him water with Gatorade from your Ten Essential Systems and a ClifBar or equal. Get him in a better hat and glove system, add a wool scarf from your pack. Give heavy stuff from his gear to others who volunteer. Ten Essential Systems

Tell him to snap out of it! Tell him not to be embarrassed. Make him engage in conversation. Have him empty his bladder because his body may be trying to maintain his urine at 98.6 degrees at the expense of his hands and feet. Have him exercise vigorously in place, drink a bit and eat a snack, if he can. Tell him exactly how the group can get back to camp or car. Explain that the alternative may be very bad. Have him hike right behind you with a strong buddy who can help and encourage him to get back to shelter. "Short rope" him to a strong companion too, if feasible.

If you have waited to long to discover and deal with the problem of a single hypothermic companion who might have been revitalized, you may have to "shelter" to care for him.
Contact 911 now, if you have not!
Firstly, starting a fire in a snow storm is generally impossible; “sheltering” in the snow requires special skills, insulating pads and snow shovels, and sleeping bags and stoves with pots: i.e. all companions geared up for an overnight "bivy". It can take an hour or more to construct a minimal snow cave "shelter" for two persons, hours to bivy a group in a storm. Why are snow caves dangerous?

If you can solve the problem of "shelter" in a snow storm with your group snow shovels, pads and sleeping bags, you can gently add warmth to the victim.
1. The Patient has been unable to generate enough heat to reverse his hypothermia.
a. You will have to add heat if he or she is to recover.
b. You should not put him in a sleeping bag with a quart of warm water and let him go to sleep!

2. Gently remove the Patient's wet clothing.
a. Do not massage a hypothermic person! You must not move the cold toxic blood from his extremities to his core.
b. Get him into extra dry clothing and a sleeping bag. Keep him awake and engaged.

3. Add warmth to the victim.
a. Give him warm drinks and sweet snacks.
b. Use commercial heat packs such as "Little Hotties Warmers" (I kid you not, they are an Official Supplier to the US Ski Team!)
c. Place warm Nalgene or Platypus water bags or bottles at his armpits and groin. Wrap the water bags or bottles; do not burn the victim!

    Note: Don't carry a 2 ounce MSR stove and 3 ounce Propane can and a quart pot on a winter hunt or climb? Shame on you!
    Here is a Traditional response we have discussed in theory: Have volunteers take a big drink of their water, add the rest of their water to companion's bags or bottles, then pea in their bag or bottle,
    close it well and warm the victim with pea at 98.6 degrees. The victim will buy you new bottles, if he survives. You should be using wide mouth bags in the winter, (so you can add snow as you go).
    You can keep bags, not bottles, from freezing, in the big pockets in your mid layers or big DAS Parka Belay Jacket

4. If the Patient is semiconscious or worse, add heat very carefully:
a. Do not massage a semiconscious hypothermic person! You must not move the cold toxic blood from his extremities to his core.
b. Use commercial heat packs such as "Little Hotties Warmers" (I kid you not, they are an Official Supplier to the US Ski Team!)
c. Place warm Nalgene or Platypus water bags or bottles at his armpits and groin. Wrap the water bags or bottles; do not burn the victim!
d. Do not try to give him food or drink that may choke him.

5. If the patient is unconscious:
a. Understand that the patient can not reverse the hypothermia themselves; external heat must be applied to reverse this condition!
b. Leave the patient stripped naked (to dry underwear, of course) and carefully put the patient into a warmed winter sleeping bag on top of several ensolite pads, with one or more persons stripped naked (to their dry underwear, of course) who will act as heat donors. Skin to skin full body contact is required to be effective in warming a hypothermic patient.

    Note: On one 1980's traditional crevasse rescue on the Fisher Chimneys Route on Mt. Shuksan in the Washington Cascades, two young ladies were stuck between walls of ice, deep in the crevasse.
    Several rope teams of climbers were available, but it took a long time to extract the women and they were in mid-stage hypothermia. Teams of climber/donors ran up and down the glacier until they
    were hot and sweaty, before getting into the sleeping bags with the two semiconscious hypothermic young ladies awaiting helicopter transport. The Mountaineers

    Note: Guided groups and school groups no longer advocate the the traditional "naked heat donors" method. On the advice of Counsel, they prescribe the less effective "burrito wrap" with tarps, sleeping bags
    and warm water bags and bottles.

    Note: The hospital can remove all of the patent's blood, clean and warm the blood and return it to the patient. Don't try to do this yourself in the field!

6. Call 911 if you have not! If you have not, you have waited too long!
a. Use your ordinary cell phones (warm from a pants pocket) and/or your warm $149.00 SPOT GPS Satellite Messenger with Lithium batteries, to contact SAR through 911. Batteries cold? Use new Lithium batteries kept in a pants pocket or warmed with a Little Hottie Hand Warmer. Take the search out of Search and Rescue! SPOT GPS Satellite Messenger reviewed
b. If you can connect using a cell phone from the several in your group, give the SAR Incident Commander your UTM (NAD 27) GPS Coordinants. Describe your group and your current situation. SAR may advise you to "shelter" where you are or perhaps that you are "just a half mile walk at 180 degrees true, across the snow field to the Trail Head". Check your map!.  Two climbers become lost descending Mount Hood 
 

COLD INJURIES:
Hypothermia will surely be accompanied by cold injuries such as frostbite or worse. This is a separate medical condition. Read "Backcountry First Aid and Extended Care" by Buck Tilton for the Wilderness Medicine Institute of NOLS for care of cold injuries and hypothermia patients. Expert skier lost for days, off piste in Washington.

Plan your trip well, stay hydrated, nourished with simple carbohydrates, in a continuously aerobic state, dry and protected by your clothing and accessories from wetness and heat loss from conduction, convection, radiation, evaporation and heavy respiration! Mount Hood, the Episcopal School Tragedy.
Copyright©, 2010 by Robert Speik. All Rights Reserved.

A suggested minimum standard media advisory for all backcountry travelers

"We would like to take this opportunity to ask our visitors to the backcountry of Oregon to Plan for the unexpected. Each person should dress for the forecast weather and take minimum extra clothing to provide protection from a drop in temperature and possible rain or snow storm or an unexpected cold wet night out. Each person should carry high carbohydrate snacks, two quarts of water or Gatorade, a topo map and declination adjusted base plate compass and an optional inexpensive GPS (and the skills to use them together). Each person who has a cell phone should carry their ordinary charged cell phone (from a service provider that has the best local backcountry coverage). An inexpensive SPOT-2 GPS Satellite Communicator is a good additional option for some. Each person should carry their selected items from the new 'Ten Essentials Systems' in a day pack sized for the individual, the trip, the season and the forecast weather."

"Visitors are reminded to tell a Responsible Person where they are going, where they plan to park, when they will be back and to make sure that person understands that they are relied upon to call 911 at a certain time if the backcountry traveler has not returned. Call 911 as soon as you become lost or stranded. You will not be charged. Do not try to find your way until you are benighted, exhausted, or worse yet - wet. Your ordinary cell phone call to 911 can take the 'Search' out of Search and Rescue."

THE MISSION of TraditionalMountaineering.org

"To provide information and instruction about world-wide basic to advanced alpine mountain climbing safety skills and gear, on and off trail hiking, scrambling and light and fast Leave No Trace backpacking techniques based on the foundation of an appreciation for the Stewardship of the Land, all illustrated through photographs and accounts of actual shared mountaineering adventures."