First Aid Unboxed Episode 18 – Hypothermia & Cold Weather First Aid

Disclaimer
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This podcast provides general information and guidance on first aid treatment. It is not a substitute for professional medical advice or certified first aid training. Always seek the advice of a qualified healthcare professional for any medical concerns or before making any decision related to your health or treatment. In a medical emergency, always call for immediate medical help.

Hello and welcome to episode 18 of First Aid Unboxed with me, Mark Wakeley, asking all the idiot questions. And of course, the expert in the room, who is Louise Madeley, fully medically trained, I think we could describe you as.

Louise
Good afternoon. The idiot in the room.

Mark
Yeah, well no, I'm the idiot in the room, definitely, there's no doubt about that. Right then, you've given me my little crib sheet and you've put on hypothermia, the core danger. So is that what we're going to be talking about this week?

What Is Hypothermia? Understanding Low Body Temperature

Louise
Yeah, it's that time of year again. Temperatures are starting to get colder, as we know. We are no longer in summer. We're getting our way through autumn quite rapidly. And hypothermia is always a concern when it comes to the winter months, particularly with the elderly and the very young and those most at risk, our most vulnerable people in society.

Mark
As ever, it's always the old and the young, isn't it, who are the most vulnerable with any of these things?

Louise
Generally, or those that have medical problems, that means that they can't get around as easily. and so on. It's the most vulnerable people in society that are at the greatest risk. And that also includes people who are homeless, et cetera. It's not just elderly and young, it's anybody who's in a vulnerable situation.

Mark
Let's start off by asking the obvious question. What is hypothermia?

Louise
Well, there's two different types. We're only going to be talking about one type today. You have primary and secondary, basically. So primary is the fact that you have a lack of heat, and as a result, your body temperature drops. And as it drops, it gets below 35 degrees. When it gets below 35 degrees, then we class them as being medically hypothermic. Hypo being low, thermal as in temperature.

Mark
Temperature, right.

Louise
So low temperature. The second type is secondary, which isn't part of what we're going to be talking about today. But generally, that's caused, say, somebody has sepsis, which we've talked about in another podcast before, and as a result, their vessels expand. And when they expand, you have a greater surface area so that they can reduce their heat. Unfortunately, their heat reduces so that it goes too low and goes below 35. But again, that's down to medical conditions and other more internal problems as opposed to external where heat has been taken away and we become hypothermic or low temperature.

Normal Body Temperature vs Hypothermia

Mark
Because we operate as an optimum temperature, don't we, as human beings?

Louise
Absolutely.

Mark
And it's quite a small window from what I know.

Louise
Yes. Well, any biochemistry, anything at all within the body, it's actually very narrow margins that we work towards. Working in intensive care, for example, we are constantly just working on these tiny little parameters. And we can be talking about micro measures, literally. And it's the same with your body temperature. 36.5, pretty good. That's your optimum temperature for your body and your organs to be working and functioning properly.

When you start going upwards, you're only talking 37, 38. Once you get to 38.5 to 39, then you are hyper. It's the other way.

Mark
I suppose a hypo.

Louise
Absolutely, hyper is always up, hypo is always down. So yeah, once you get to that sort of temperature, your body wants to blow off a load of this heat because it's not working efficiently when it's got a high temperature. Therefore, all the vessels open up, increase surface area to force your body to reduce its own temperature.

The other end of the scale is the exact opposite, where you become hypothermic, so below 35, So ideally we need to be around the 36, 36.5. My body temperature generally usually sits about 36. That's pretty standard for me.

Hypothermia Symptoms: How to Recognise Someone Is Too Cold

Mark
Okay, recognising hypothermia. So hypothermia, you've got to make sure we say hypothermia.

Louise
Hypo.

Mark
Yes, with an O. So recognising that, what are the things that we need to be looking out for?

Louise
Well, generally it's caused by prolonged exposure, whether it's cold or wet conditions, it could be that, You've, for example, fallen into a pond, your clothes are wet, et cetera. And as you're bought out, you remain in that cold situation. So it can be wet conditions as well as cold. It affects everything. It affects the brain, the vital organs. The trick is to make sure that you get help immediately. So recognizing hypothermia, you're looking more at things like shivering. We've all got cold and we've all started to shiver. What's actually happening is it's a natural body response to the fact that you are getting colder.

Mark
So it's trying to warm you up by movements.

Louise
Yeah, absolutely. Your muscles are shaking and they're vibrating together for the purpose of warming your body up. That's the whole point of it. So shivering is a really good thing. It's a natural response that you want to do as you start to feel cold. However, in severe cases, the shivering stops and that's when you need to be really concerned.

If somebody is shivering and then suddenly they stop and it's not because they have warmed up and their temperatures got considerably better, then that's a big red flag, put it that way. They may be cold, pale, start to get that blue tinge. You know, I've talked about it before when they become cyanotic, we call it. Again, that's a lack of oxygen getting through the capillaries into the skin.

Slurred speech, mumbling as well. Sounding drunk, really, that sort of mumbling, and it can lead to confusion, drowsiness, impaired judgment, decision-making, very difficult, very slow to do, and slow, shallow breathing, and eventually a weak pulse, lack of coordination, stumbling, and it can lead to unconsciousness.

Mark
So you're slowly shutting down, basically.

Louise
You're doing exactly that, yeah. The same as anybody who is experiencing a lack of oxygen to the system as well. You know, the brain is slowing down, all the organs are slowing down, everything is going into shutdown mode.

Hypothermia First Aid: What To Do in an Emergency

Mark
So if someone is presenting those symptoms, what's the first thing we need to do?

Louise
If they're presenting with those symptoms in particular, then we're talking about somebody who is already in the stages of hypothermia, in which case it is a medical emergency, call 999 immediately.

Mark
Okay.

Louise
It is a medical emergency, and as such, it's really important that you can recognise those signs of hypothermia, particularly if you're going into elderly houses, et cetera, grandparents that a particular age. and there may be the chance that they could become hypothermic. It's really important that you recognise and understand what to expect if you think that somebody may be hypothermic.

Mark
And that's a medical emergency 999.

Louise
Absolutely.

Mark
Okay.

Louise
Certainly is. The second thing really is to move the person into a warm, dry place because if they are, say they're at home and they've become cold because they've been sedentary, they're sitting in their chair, they may have just a blanket over them and their temperature in the room is too cold. And we'll talk about that in a minute. They may become hypothermic over a length of time and not realize just how cold they are because you feel cold to begin with, but after a while you may not feel that cold.

Mark
So this can sort of creep up on you a little bit.

Louise
Absolutely. Particularly with the elderly. They could well be at the stage where their brain is not functioning as well as it should be. And they've sort of gone through that stage without realising. So you may be walking in on a situation where they're not fully compos mentis.

Mark
So they're in that confused state that you were talking about earlier on?

Louise
Yeah. And it's important to recognise that that's what it is and that this is a medical emergency. and call the ambulance as quickly as possible. But try and get them into a warm, possibly dry place. If it's wet that's caused the cold, then you need to remove their clothing, for example, get them into a warmer clothing. not even necessarily warmer clothing, but dry. Get them into, it would dry them off and get them into dry clothing and then use layers to get them warm.

Mark
I know it's about layers, not necessarily about having one big thick coat, it's about having lots of layers and the heat is trapped between the layers, isn't it?

Louise
Is. Yeah, absolutely. So... Get the person out of the cold, into warm, sheltered area if necessary, if they're not in a sheltered area already. If they're indoors, then wrap them in blankets. Make sure that you close any windows or doors just in case there's any draughts that may be causing an issue and may have been what's made them feel that cold.

If you're moving them indoors, then provide them with insulation from the ground in particular. So if it's that they were outside and they've fallen over, and you need to get them indoors, then make sure that, firstly, you do it very carefully, but that you've got something underneath them, whether it's a sleeping bag, blanket. When people get cold and they're outside, it's not the air temperature that's the big risk, it's the ground temperature. Get something underneath them. If you can't move them inside, then just make sure, whether it's using a log roll or very carefully roll them onto their side, get something underneath. roll them the other way and pull it through so that they've got something completely covering them.

Mark
Even the cardboard box type material can help, can't it? Because that's sort of hollow inside.

Louise
Yeah, well, I remember the days of Box City in London, and yeah, that's what everybody was sleeping on, cardboard boxes, just to give them that little bit of elevation away from the ground and insulate against the ground. Then you can always throw things over the top, coats, et cetera, but get something that's as thick as you can underneath them to keep them away from the ground if they are outside.

So the next thing you need to do is warm the core gradually. It's really important that when we warm somebody, when they are hypothermic, that we warm them gradually. You don't want to put direct heat all over a person. So hot water bottles sort of covering the body in them, that's not the answer. It's about heating the core.

So wrapping them in blankets or coats, great. Chest, neck, groin are the important places. Using warm, not hot. So hot water bottles, no. Water bottles, yes, but not roasting hot. And always make sure, obviously, that you put them into something safe because you never put heat directly onto skin anyway. The same with cold, you never put anything directly onto the skin. The last thing you want to do is cause burns or put them into a state of shock.

Mark
I was going to say, can it create a state of shock if they have warmth thrust upon them all of a sudden?

Louise
Yeah. Yes, it does. Suddenly you will get vasodilation. So you'll get these, the veins and the arteries suddenly becoming very enlarged, which is not what you want. It's the opposite of what you would like to do. So yeah, you need to do it very slowly, very carefully.

Warm drinks, if that person is conscious and has a good swallow, somebody can be conscious, but they may still have quite a poor swallow at that point. So make sure that you're happy and confident that they are going to be able to swallow okay. And give them, again, warm drinks. Non-alcoholic, it is not a question of give them a nip of sherry or a nip of brandy, whiskey, et cetera, please don't, stay away from alcoholic drinks. Tea, hot chocolate, sugary food as well. Give them a little burst of energy. Perfect.

Mark
Putting their glucose levels up.

Louise
Yeah, absolutely. Yeah, and like I said, never give them alcohol. Avoid caffeine if you can. Tea and hot chocolate, sorry, do have small traces. They have a little caffeine in them.

Mark
But a double espresso is not a good idea.

Louise
Not recommended, no.

Mark
Okay.

Louise
Yeah, double shot, bad.

I keep monitoring them. Monitor their breathing. Don't forget, in this time you are waiting for the ambulance to arrive. So all you're doing is first aid. This is not a treatment plan or anything like that. We're not medical professionals doing it. We are talking about basic first aid. gently warming them until the paramedics arrive. That's what it's about.

Mark
So you're trying to stop the situation getting any worse as opposed to make it any better. Just stop the decline until the ambulance people get there and they will know exactly what to do.

Louise
Yeah, it's the usual. It's preserve life, it's preventing it from getting any worse, and as a result, you will promote recovery. It's basic first aid. However, you do need to think they're already in a state of being very poorly here, so always think I may. need to do CPR. Always prepare for the worst. Doesn't mean the worst is going to happen, but if you prepare for it, then it's less likely.

Mark
So if you want to know more about CPR, you go to episode 5 of the series First Aid Unboxed, and that is a whole episode all about CPR. So you can have a listen to that as well if you need to brush up on that particular subject.

Hypothermia First Aid Mistakes to Avoid

Louise
The key do nots, really important. There's a lot of fallacy out there about what we do and what we don't do. The do nots that are really important, for example, do not rub or massage their limbs. It actually forces cold blood from the extremities back into the core, causes dangerous rapid drop in core temperature. And this can trigger cardiac arrest apart from anything else.

So do not rub or massage their limbs. I've mentioned before, Give them alcohol or caffeine. That's an absolute do not. But also do not give them a hot bath. Direct and fierce heat, which I've mentioned already, but the key is the hot bath. It's something that we did used to do years ago, my grandparents would have done. If I was cold, first thing they'd think about is put me in a hot bath. That is not advisable at all.

What it'll actually do is cause you to go into shock and cause stress to the heart. And again, put you at risk of cardiac arrest. So really important that we don't do these.

Preventing Hypothermia at Home in Winter

Mark
So we've talked about what it is and the symptoms and what we can do to stop it getting any worse. How can we stop it happening in the 1st place? What are the preventative measures that we need to take?

Louise
Again, we can talk about the first aid and what we need to do, etc, and how to recognise it. But actually, if we can prevent it happening in the 1st place, that's always the place to start. Prevention's always better than cure. We know this.

And it is important that we look at things like people's insulation, heating, and their personal health. Unfortunately, we do live in a time where there is a significant amount of fuel poverty, for example, and it's not always that easy to keep your home heated. And the best way to do that is to make sure that you work towards the target temperature for your house or for the room that you're in.

So if it's a question of you can't keep the whole of your house warm, the key places to keep warm are the room that you are staying in the most, be it the living room, sitting room, whichever, and the bedroom. Ideally, they need to be between 18 and 22 degrees Celsius for you to not start to slip into hypothermia. I know that's not always possible, but there are other things that you can do.

For example, sealing any gaps, draught excluders at doors, rubber seals at the windows. I know some people who use cling film at windows. That's quite an effective way of keeping draught at bay. Closing doors to unused rooms as well, and draught excluding to the rooms that you're not going to be using. If you need to go down to just using two rooms in your house, then that's what you need to do in order to stay warm.

It's too important that you do stay between the 18 and 22 degrees. If that means heating two of your rooms instead of the whole house, then so be it. That's what needs to be done. Using curtains wisely as well. Open curtains in sunny rooms during the day. Close them tightly as dusk falls. just to trap in the warmth. It's just a little tip. It's the opposite of what we would do if we were talking before about it being exceptionally hot during the summer. We're effectively doing the opposite. We're trapping the heat inwards instead of trying to keep it out.

Mark
I think we forget that everything in our house is like a story teeter, you know, your sofa and your carpet and everything else. So it will store some of the heat and release it during a colder period.

Louise
Yeah, heat is energy. Absolutely. Heat is energy and you can trap it within your within the walls of your house, in which case do so if you can. So if you've got a room that's got a very sunny position, for example, during the day, then keep those curtains open and as it turns to dusk then close them, you will trap some of that warmth inside. That would probably be the room that you would want to use in the evening, for example, rather than the one where it's a north-facing wall that may not get much sun.

So choose the room that you are going to warm wisely, shall we say. So using curtains wisely is always a good idea idea. Thermal linings work really well as well. We've got thermal linings in most of ours because the back of the house, it's all single glazed and it's north facing. So we don't tend to use the back of the house that much in the winter. We've got a snug in there which is lovely. We'll use it during the day. But at night we do tend to use the front of the house which is the living room. and it's where the sun goes in. And we've also got double glazing in the front. So we tend to use the front of the house more than the back, certainly in the winter months.

So think about whether you've got single or double glazing, thermal linings if you have got single glazing, thermal linings are fantastic. And again, using things like cling film if you haven't got secondary glazing.

Carbon Monoxide, Heating Safety and Winter Risks

Louise
Yeah, crucially during winter months, Safety check your appliances. Risk of carbon monoxide poisoning always increases because again we are draft excluding our house. There aren't the drafts that we would normally have and the natural ventilation and at the same time we have appliances switched on. So carbon monoxide poisoning does increase during the winter months.

in which case make sure that you get everything safety checked and if you have a carbon monoxide detector, fantastic. So ensure your heating and cooking appliances are checked by gas safe registered engineers. If you go onto the NHS website, you will find a link that gives you the gas safe registered engineers and fit an audible carbon monoxide alarm. It needs to meet British or European standards, which is BSEN 50291. Very important that you do have a carbon monoxide alarm and an audible one as well, so you are able to hear it.

Keeping Yourself Warm: Clothing, Layers and Movement

Louise
From a personal point of view, it's about layering, as Mark mentioned earlier. It's very important that you use layering.

Mark
Is it a myth that we lose loads of heat through our head, or is that true?

Louise
No, we do.

Mark
So wearing a hat's quite handy.

Louise
Very handy.

Mark
All right.

Louise
Yeah, absolutely. As you said before, air does trap between multiple thin layers, which is why thin layers are better than just wearing one big blanket. You're gonna stay warmer if you use layers. much more insulated.

Hats, gloves, thick socks as well. You lose a lot of heat through your head and your feet. And again, we're talking about ground temperature. If you've got your feet on the floor and you've just got thin socks on, you are going to get cold from your feet, which is what we're trying to avoid.

And using movement and activity wherever possible doesn't necessarily mean getting up and walking around all the time if you're not that mobile. It could just mean passive exercises that you're doing. A bit like when you're in an aeroplane and they give you those exercises for your feet to keep turning your feet around, etc. Moving your arms, moving your muscles. Every time you move your muscles, your muscles are vibrating, they're moving together, they're creating warmth. So use what you have.

Movement is really important, but it doesn't have to be going for a run or anything. anything major like that. It can just be gently moving your wrists, doing the funky chicken, just gradually lifting your arms up and moving things around.

Mark
I'll tell you right now, Louise, he's doing the funky chicken.

Louise
I did actually do the funky chicken. That was a sight to behold.

And nutrition and hydration. Important that we eat well and consistently. We need to eat three times a day. Your body needs the energy from food to shiver and generate heat. It's as simple as that. A variety of foods as well. Make sure you have at least one hot meal A day. hot drinks throughout the day, even if it's a bowl of soup, anything that you can get into your stomach that has warmth to it, that warmth is essential.

Checking on Elderly Neighbours and Vulnerable People

Mark
So that's fantastic. So prevention is always much better than cure in any of these situations. And that goes for anything that we talk about on this podcast. So the other thing, of course, is to keep an eye on not only the people in your house, but other people, neighbours, relatives, and so on. This is quite an important part of of prevention as well, isn't it?

Louise
Certainly is. And certainly from my point of view, it's the most essential thing that we can do for each other as a community.

Hypothermia can develop in vulnerable people after a relatively short exposure to cold weather. It's as simple as that. Relatively short exposure is the key. It's not like myself who I'm 53, I'm very active, etc. A relatively short cold exposure isn't going to do a great deal of damage to my body. However, I'm not somebody who is in my 80s who may be sedentary, not able to get up, sitting at home, who is gradually getting colder and colder and colder.

It doesn't take long for an elderly or very young person to become cold. They can't regulate their body temperatures in the way as active, running around people can. It's as simple as that. And it can develop just after a small drop in room temperature. We're not talking about plummeting temperatures here. We are talking about a small amount of very minor in a reduction in temperature.

So checking on your neighbours. It's often the elderly, those with mobility issues, those struggling financially that are at the greatest risk. They are the people that we need to keep an eye on, whether it's relatives, whether it's friends, neighbours, anybody in your community that you know may be on their own or who may be struggling, may be vulnerable.

So it's important for us to check on our neighbours safely and effectively. For starters, when you check in, ask if their home feels warm enough to them. Look out for visual clues as well. Are they wearing a coat indoors? Perfect example. Are they reluctant to open the door fully? If they answer the door and they just open it a crack and they've got an indoor coat on, that is a very big red flag that they are not warm enough in their home.

They may not want to outwardly come outside and say, look, I'm struggling, et cetera, but if you notice these visual clues, then that's when you need to act. Offering practical assistance, so can I pick up your prescription from the pharmacy? Can I clear ice from your pathway so you don't fall? Do you have enough non-perishable food in if the roads get bad? Anything like that is always bad. of benefit.

Using other resources as well, Age UK are absolutely fantastic for resources on what to do for vulnerable people during these times, especially when it comes to energy efficiency improvements, anything like that. Age UK are fantastic.

And recognising the signs as well, if somebody appears unusually confused or sleepy, speech becomes slurred, the house feels cold in any way. And it's about consistency, going and seeing them regularly, just popping in, just sticking your head round the door. Are you okay? It's the simple things.

And if in any doubt whatsoever, then call for professional help.

Mark
Call 999.

Louise
Yes, absolutely.

Mark
Everything in the UK, of course.

About Madeleys First Aid Plus and How To Get in Touch

Mark
Okay, that is fantastic, Louise. Thank you for that. Lots of stuff for us to think about. If you're not sure, have a listen through to the podcast again. There's also a transcript available on certain platforms that you're listening on. So you can always check through that as well.

Louise is a medical professional, obviously, and she runs a medical professional training company. If people want to get in contact with you, first of all, Louise, what's the best way to do that?

Louise
By e-mail at enquiries@madeleysfirstaidplus.co.uk or through the website www.madelysfirstaidplus.co.uk

There is now a WhatsApp button on there, so please, feel free to send me a message via WhatsApp. Much appreciated if you do.

Mark
And Louise can't answer any questions that you've got about this episode or any of the episodes that we've recorded in the past.

The other thing on the website is all the details of what you actually do in the training that you do and anybody wants to book on can book on through the website, yeah.

Louise
Absolutely. Or again, send me a message through WhatsApp or you can book on directly. That's absolutely fine.

Mark
Brilliant. Brilliant. Okay then, if you've enjoyed what you've heard and you think it's useful and interesting, then please review and subscribe and follow us. It really helps with the algorithms. Algorithms, we all live by algorithms these days.

We'll be back next month with another first aid unboxed. So have a look out for that. And I said, if you don't wanna miss it, then subscribe. That's the best way is not to miss it.

Thank you to everybody who is listening. We're getting lots and lots of listeners, which is really lovely. And people all over the world are listening to the podcast, which is equally good. So thank you very much.

Thank you very much Louise for all your expert insights today.

Louise
My absolute pleasure as always.

Mark
And we will see you all next month.

This is a 1386 audio production.

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