27 February 2021

Treating Hyperthermia

Hyperthermia is becoming too hot. It can become very serious on the mountain or water. If there are other injuries involved - they are your secondary concern. However; different to hypothermia; generally if someone if suffering from heat exhaustion, followed by heat stroke - this is usually your main and only 'injury'. If their body core becomes too hot (heat exhaustion, followed by heat stroke/hyperthermia) - you need to cool them urgently.

Click Here To See The Recognition Signs For Hyperthermia

1. Stop sooner rather than later. Stop before the situation has spiraled into something very serious. You do not take heat stroke/hyperthermia lightly - is is very serious and can become life threatening.

2. This has probably happened because your patient arrived not fully prepared/slightly dehydrated/hungover. They perspired too much, did not carry enough fluids, did not drink enough fluids. Maybe their fitness levels were not up to the route. Maybe your route was simply too long and too exposed for such a scorching hot day. This is all preventable - and prevention in the first place is obviously much more ideal.

3. Find shade out of the sun. You may be able to utilise a breeze to help cool them, simply by moving from one side of a boulder to the opposite side, or from one side of a ridge to the opposite side.

4. As well as finding shade from the sun, you can build shade by making a barrier of bodies between your patient and the sun. You can spread out a storm shelter/kissu, survival bag, foil blanket or map - like an umbrella - between your patient and the sun. You could build something quickly, utilising the landscape you have around you - so a pit in the sand, a pile of stones, a pile of branches/debris.

5. Strip your patient down to the bare minimum of layers. Especially - ensure their footwear, socks, gloves, hat are all taken off.

6. If possible immerse them into a river, stream, boghole. The shock of full immersion into cold water will not kill them - don't worry. Don't immerse them into a river if there is any risk of being swept away.

7. If you have no cold water immersion access then sponge down your patient with water, especially focusing on their head and upper body. Dirty water from a bog hole or stream is fine as it is not being ingested. Save your clean water for drinking.

8. Fan your patient with a map to generate a breeze and help with cooling.

9. From the very start of this process they need to be drinking water. Constant sips, little and often. Hydration drinks such as a dioralyte sachet poured into their water bottle is best. You can make up a simple and highly effective hydration drink (details here).

10. Plain water by itself is not ideal at this point. Really they need to be getting salt and sugar back into their body urgently - to replace what they have lost through sweating. Carry hydration material in your first aid kit (such as dioralyte sachets).

11. Asses the ground your patient is sitting on. The ground may be warm, or rock/sand may be dangerously hot for your patient; so sitting on a backpack could be a better option. Sitting rather then lying could be a better option. Turn over hot rocks to sit on their cooler underside. Dig into sand to reach cooler ground lower down. Deeper you dig the cooler the ground will become, plus the deeper you dig the more likely you will reach dampness or water - which can be useful.

12. Food and drink. Ensure they are fully conscious, not sleepy/drowsy, with the possibility of choking on food. Even if not hungry/thirsty it is important to get fuel into them. Amounts little and often of good food such as brown bread sandwiches, and bad food such as chocolate/jellies. Both types of food are needed. Hot drink can be poured into a cup to cool for later. No coffee - it is no good for their compromised system. No caffeine energy drinks, again bad for their system. No alcohol.

13. The emotional care you give is hugely important. They need to feel calmed, reassured, as relaxed as possible, that they are in calm/confident/competent hands. They do not need to overhear conversations about how quickly they are failing, how serious the situation is. They do not need to see anxious, stressed, whispered conversations going on across the spot height. I would nominate someone to sit with them, hold their hand and talk with them/reassure them. It is important to find the balance with not bombarding or exhausting them with talk and questions!

11. Get vital signs (pulse and breath) regularly, so you (or mountain rescue) have a picture as to whether they are getting better or worse. Write them down or type them into a phone.

12. Get allergies, medical issues, past medical history. Record it all. This is important in case your patient deteriorates; or if they suddenly have a fit - it is great to know in advance that they suffer from epilepsy for example.

13. Better to call for help too early rather than too late. Mountain Rescue would much rather you call them before the situation has become desperate. I find a good rule is, if you begin to wonder should you possibly call mountain rescue; then it is time you called them!

14. Calling for help; ring 112 or 999. Both are identical. With no phone reception try anyway. Your phone may well piggyback onto another network in the area that has reception. If you are the most experienced person, you will probably be dealing with your patient; so nominate someone else to make the emergency call.
A. You initially get through to central dispatch.
B. Ask for mountain rescue (ideally know who your local team are; for example in Kerry and Cork you are asking for Kerry Mountain Rescue).
C. You are transferred to the main garda station, where a guard will take some details, then hang up.
D. Your phone will ring with a member of the mountain rescue on the line to take it from there. This may take 5 to 20 mins before mountain rescue contact you.
E. Starting to happen with smart phone technology - is a text message also comes into your phone with an app you open, which gives you/mountain rescue your exact location.

15. When do you call for help? Completely depends on weather/location/distance from road/severity of patient/other injuries of patient/your level of emergency gear/your level of experience. Some people would call at the UMBLES stage. Some people would do full above treatment, wait and assess for 30-60 mins, then decide to call or to walk off hill with patient. Both can be correct - it is all down to your exact circumstances.

16. Even if your patient is recovering, if in any doubt call for help. The energy required to walk off hill may push them back into the danger zone again.

17. Cold pads can be used. They are not essential and I don't personally carry them. However they can be useful. Put them as close to the body core as possible; inside armpits, against stomach, against lower back, between thighs - right up in groin area. Watch they don't ice-scorch your patient and watch they don't leak/burst.

18. Split Party? If one person has become hyperthermic, chances are conditions have others in your party also at risk. There is no right or wrong answer to splitting your party. Sometimes it can be good for some of your party to continue on downhill to safety. Sometimes it is better to stay all together. You can imagine what a nuisance it becomes if some of your party continues on downhill; then gets lost, gets injured, or you discover they have gone off with an essential piece of first aid gear or extra water you need...

19. No Reception? With no phone reception try anyway. Your phone may well piggyback onto another network in the area that has reception. A phone will make an emergency call even when locked/without pin code. With terrible reception/terrible weather conditions you can send an emergency sms text message to 112. You need to register your phone number with 112 first. Details here: www.112.ie/Sending_a_text_to_112/144.
With no reception whatsoever you move about, constantly trying to dial, and watching your signal bar icon. Do not get lost or walk off a cliff while doing this! Try different things - climb onto a boulder, climb onto a spot height, go into the middle of a saddle. With no reception still - you are heading downhill to the nearest house/road - like in the days before mobile phones. As you proceed keep checking your phone reception. This is why it is good to have an 'escape route' pre-planned as part of your route planning/route card. You want to be vigilant, as you are most likely rushing and stressed, that you do not become lost/injured/crag-fast.

20. Only One Rescuer? Less Than Three Should Never Be is a good rule of thumb. If one person becomes injured that leaves one person for perform first aid and one person to call for help/go for help. However if you are the only rescuer; you need to first stabilise your patient for the short term (no time consuming first aid yet - just make sure they are breathing, not bleeding heavily, not about to roll off a cliff or be swept away by a stream or avalanche). Then make the emergency call as quickly as possible. Then move into your proper first aid. If you have no phone reception then you need to stabilise your patient, do your full first aid/cooling/etc, then head off for help - noting the position of your patient.

To sum up, prevention is much better than trying to cure this. Generally hyperthermia creeps in simply because someone is not drinking enough fluids, or not drinking enough specific hydration fluids; combined with a hot day.

Before completing your Mountain Skills Assessment you must have completed a first aid course. Remote Emergency Care is a great scheme. A two-day REC2 course is fine; or a three-day REC3 course is even better. I highly recommend Marie Lyons of Remote West First Aid.

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