Mounted search and rescue

["IRVIN LICHTENSTEIN" <ilichten1@verizon.net>]

If a hypothermic patient is still conscious and sufficiently coherent to accept fluids, and to do it themselves (core temp is barely depressed) maybe you will get away with it.  Administering anything as a treatment beyond Oxygen is usually outside the scope of practice of an EMT-B.  An AED is a heart monitor by the way.  Our BLS protocol says pack’em up, ship them to an ALS capable facility, without spot warming of any kind, anywhere.  Complications, such as frostbite or reduced extremity warmth, pulse, or circulation we stay away from also, because the field treatments for these are contraindicated by the hypothermia.  Depending on where the subject is found, they may have hours of “lug out” to get to a road or LZ and may actually cook the way some wrap them up in sleeping bags and foil in the Stokes.  Use of any device, medical or otherwise, beyond blankets, is also outside the scope of practice at present.  

 

One of the problems is that warming is a treatment for frostbite, but should not be attempted in the field for hypothermia. The definition of hypothermia is also constantly changing in terms of how cold the patient is and how the temp was taken.  This lack of uniformity in treatment is what allegedly lead to our state’s EMS bureau now requiring all wilderness SAR to become licensed special operations EMS providers within 2 years from now, and get some doctor who is crazy enough to be our medical director signed on as well. First aid is out, BLS is in around here.

 

Vasodilation causes the blood vessels to enlarge causing a huge increase in blood volume required to maintain flow and pressure levels.  The form of shock is hypovolemic (sp?) and is similar to bleeding out, without the blood loss.  It can also happen during the body’s reaction to any trauma where blood volume changes rapidly.

Irv Lichtenstein

SE PA SAR

 

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From: msar-riders-bounces@lists.ibiblio.org [mailto:msar-riders-bounces@lists.ibiblio.org] On Behalf Of Hill, Victoria L.
Sent: Friday, December 18, 2009 3:49 PM
To: Mounted search and rescue
Subject: Re: [MSAR] Socks

 

If I may....if the hypothermic subject is still A&Ox3 then you can begin the warming process by removing them from the cold environment, taking their wet clothes off and covering them with a blanket/s, providing those hand warmer packets to them to be placed in the axilla (armpits), groin area, and the back of the neck.  DO NOT re-warm the limbs first as this will cause vasodilation and cause the body to go into a fatal form of shock.  You can also give them WARM liquids or broth.  Do NOT rub the affected areas, and if shivering is absent transport in an ambulance.  Do not allow the pt. to walk around, do not re-warm too quickly or jostle them around as this will cause arrhythmias.  We don't require hypothermic pts to be placed on a heart monitor as none of us can carry them in our backpacks or saddlebags without a whole lot of red tape and a medical license at about the Paramedic level.  This is pretty basic first aid stuff for our state and of course as you advance up the EMS ladder you learn all kinds of things to deal with and treat hypothermia but we don't even mess with the monitors.  If the hospital wants to put them on then that's what they do....us out in the field do what we are trained to do to save the patient.  All protocols are different for each state but federal standards are what I stated above.

 

Just wanted to throw my 2 cents in.  I wish all of you a very Merry Christmas and a safe and wondrous New Year.

 

Respectfully,

Victoria L. Hill

Clay Co. Sheriff's Posse

Clay Co. Search & Rescue

AHA CPR Instructor

EMT - B

812-878-0216 Cell

Victoria.L.Hill@saint-gobain.com

P Please consider the environment before printing this e-mail

To know what is right and not do it is the worst cowardice. ~Confucius

 

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From: msar-riders-bounces@lists.ibiblio.org [mailto:msar-riders-bounces@lists.ibiblio.org] On Behalf Of IRVIN LICHTENSTEIN
Sent: Friday, December 18, 2009 3:15 PM
To: 'Mounted search and rescue'
Subject: Re: [MSAR] Socks

I usually buy through REI as there is a store nearby (Conshohocken).  Most of the hiking socks are available in synthetic only.  Polyproplene is a wicking material and the fabrics made from it are good for the innermost layer.  Gore product Gore-Tex is a membrane used as a vapor barrier in various products.  If it says Gore Tex the membrane must be the Gore product and meet certain minimum product standards.  There are competitors that perform as well but may not have the follow through on the product.  The military socks are acrylics for the outer shell and polyprop for the inner.  Wool shrinks, is organic so it can trigger allergies, and can carry anthrax spores, so the Army has gone to synthetics.

 

You can become hypothermic at +60F if there is a wind (like riding at 7 MPH) or rain (even a mist) if you get wet and then cool by evaporation.  The biggest argument for spending the bucks for Gore Tex is a nylon rain shell that does not breathe. As to other materials, staying with synthetics can save a lot of money on initial purchase and are usually easier to care for.  I have both down and Halofill vests or liners and the Halofill works just as good dry and better wet than the down does.  It is a matter of loft and the synthetics generally have their loft built into the hollow of the yarn rather than the separation of the feathers.  

 

Clarification: My Dehners have ribbed soles, not slicks.  I ride with wide, leather covered, stirrups and a padded seat roping saddle.  I usually wear full suede schooling chaps over jeans.  I carry a rain hoodie, Gore Tex lined (in my saddlebags), on sale from REI also.

 

CAUTION: When encountering a hypothermic subject current protocols are not to warm them up until a heart monitor is available and they will be warm from then on.

There is a danger of arrhythmia during the warming process and there is no sense warming someone and then getting them cold again.  What you want to do is stop any further cooling by removing wet clothes, wrapping loosely in a blanket, or similar.  Consult with your medical director for a proper protocol consist with BLS or ALS in your jurisdiction.

 

Irv Lichtenstein

SE PA SAR  

 

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From: msar-riders-bounces@lists.ibiblio.org [mailto:msar-riders-bounces@lists.ibiblio.org] On Behalf Of Lila Corey
Sent: Friday, December 18, 2009 2:07 PM
To: lhanahan@mindspring.com; Mounted search and rescue
Subject: Re: [MSAR] Socks