Page 60 - 2021 Advanced Ranger First Responder Handbook

Hypothermia Management
Hypothermia
Hypothermia, acidosis, and coagulopathy constitute the “triad of death” in trauma patients. The understanding of hypo-
thermic coagulopathy with increased mortality is critical. Prevention of hypothermia must be emphasized in combat
operations and casualty management, and at all levels of care. Hypothermia occurs regardless of the ambient tempera-
ture; hypothermia can, and does, occur in both hot and cold climates. Prevention of hypothermia is much easier than
treatment of hypothermia, therefore prevention of heat loss should start as soon as possible after the injury. Keep in mind
that hypothermia becomes a cardiac event as much as a temperature event.

TCCC Application
Care Under Fire: No specific action.
Tactical Field Care: All attention should be directed toward preventing heat loss. Stop bleeding and resuscitate ap-
propriately. If available, warm fluids should be used. This will start generating internal heat that facilitates rewarming.
Minimize the casualty’s exposure to the elements. Keep protective gear on or with the casualty if feasible. Remove and
replace wet clothing with dry if possible. Get the casualty onto an insulated surface as soon as possible. Apply the
Ready-Heat Blanket from the Hypothermia Prevention and Management Kit (HPMK) to the casualty’s torso (not directly
on the skin) and cover the casualty with the Heat-Reflective Shell (HRS). If an HRS is not available, the previously
recommended combination of the Blizzard Survival blanket and the Ready Heat blanket may also be used. If the items
mentioned above are not available, use dry blankets, poncho liners, sleeping bags, or anything that will retain heat and
keep the casualty dry. Warm fluids are preferred if IV fluids are required. Placement of a temperature dot on the forehead
of the patient will assist in monitoring changes in the patients’ response to treatment and will serve as a visual “clue” to
remind providers to monitor the patient’s temperature throughout the evacuation process.
Tactical Evacuation: Use a portable fluid warmer capable of warming all IV fluids including blood products. Protect the
casualty from wind if doors must be kept open.
Extended Care
Hypothermia will result in decreased clotting ability in the trauma casualty. Prevention is the key to management, since
only limited rewarming is possible in the field. Minimize the casualty’s exposure to the elements. Keep protective gear
on or with the casualty if feasible. Remove wet clothing and replace with dry garments if possible. Wrap the casualty
with available insulating material (e.g., CoTCCC-recommended commercial systems, sleeping bags, or anything that will
retain heat and keep the casualty dry). If resuscitation is required, use warmed IV fluids if possible.

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50 SECTION 6 HYPOTHERMIA / HEAD TRAUMA