Profound Hypothermia Treatment
Treatment in the backcountry is aimed at stabilizing the person and preventing any further cooling.
Handle the person very gently. Rough handling may cause his heart to fail.
Place the person in a sleeping bag, or place blankets or clothing underneath and on top of him. Any heat that you can provide will probably not rewarm the person but will help prevent further cooling.
A person with significantly altered mental state should not be allowed to eat or drink because of the potential for choking or vomiting.
Rewarming is best done in a hospital, because of the potential complications associated with profound hypothermia. Professional assistance is usually needed to evacuate a profoundly hypothermic person.
Caution: First-aid management of hypothermic victims should not be based solely on measurements of body temperature because it is often difficult to obtain an accurate temperature in the field.
It may be difficult to distinguish whether a person is profoundly hypothermic or dead. The profoundly hypothermic person may have a pulse and respirations that are barely detectable. Double-check carefully, feeling for the carotid pulse (it is found on either side of the center of the throat where the carotid artery goes to the head). Check this for at least one minute since the heart rate may be very slow. Place a glass or plastic surface next to the person's mouth to see if it fogs up.
When to perform CPR: If the person is breathing or has any pulse, no matter how slow, do not initiate CPR, as this may cause the heart to stop beating completely. If there is no sign of a pulse or breathing after one minute, what to do next depends on your situation:
If you are alone or with only one other person, cover the hypothermic person and place him in a protected shelter (place insulation beneath and on top of him). Both rescuers should go for help and stay together for safety.
If there are multiple rescuers, and it is safe to stay with the victim, begin CPR. Chest compressions should be done a t on-half the normal rate. At least two people should go for help and stay together for safety.
If the person can be easily transported out of the backcountry in an improvised stretcher, the rescuers may elect to do this while performing CPR during the transport as best as possible.
Never assume that a profoundly hypothermic person is dead until his body has been warmed thoroughly and there are still no signs of life. It is possible, though rare, that one without detectable signs of life will recover when rewarmed.
Adapted from Wilderness 911: A Step-by Step Guide for Medical Emergiencies and Improvised Care in the Backcountry, Eric A. Weiss, MD