http://www.nols.edu/wmi/courses/medicine

http://www.nols.edu/wmi

National Outdoor Leadership School - Index

National Outdoor Leadership School - brochure - Index

4
THE
Leader
WILD SIDE OF MEDICINE
To Snuggle or Not to Snuggle:
Are Two People in a Sleeping Bag Effective
When One is Hypothermic?
BY TOD SCHIMELPFENIG, WMI CURRICULUM MANAGER
This is one of the enduring images of wilderness
medicine: using a warm person in a sleeping bag
to re-warm a cold person. It’s a scenario that often elicits
nervous giggles when the question of its effectiveness
is raised and then skepticism when you answer
that snuggling with a cold person is not as powerful a
warming tool as many believe.
Shivering is the best defense mechanism to produce
heat if a person has the energy reserves to shiver.
Placing a shivering patient in a sleeping bag, in dry
clothes, perhaps wrapped in a tarp—the hypothermia
wrap—allows the person to warm in the insulated cocoon
using their metabolic heat production.
If a second person crawls into the bag, they only
add 1 kcal of heat per kg of body weight per hour.
This won’t be enough to quickly reverse significant hypothermia.
In those tales where we got in a sleeping
bag and heroically warmed the severely cold person,
well, we may have done the patient a favor, but they
probably were not very cold in the first place.
What are the positives of putting a warm person in a
bag with a cold person?
• It may provide comfort for the patient to snuggle
with another person.
• You can monitor the patient closely.
• You may help the patient warm while they expend
fewer calories shivering.
• If the patient is unable to shiver—perhaps they are
severely cold or metabolically exhausted—the second
person in the bag may at least warm the insulation,
the thermos bottle of the hypo wrap, and
help keep the patient from cooling further, which
is a very important goal.
What are the negatives?
• You may not be able to fit the heat donor in the bag
and still close the opening tightly enough. This may
reduce the effectiveness of the hypothermia wrap.
• If you plan on carrying the patient with the heat
donor inside, you’ll have the weight of two to manage.
• The donor may jostle the severely cold patient, who
we want to treat as gently as possible.
Illustration by Joan Safford
• The heat donor is not on the surface doing important
tasks such as building a fire, preparing shelter,
hot drinks and food, and making sure their companions
are not also hypothermic.
• When the heat donor has tired of being in the wrap
and wants out, the nice cocoon has to be opened,
compromising the insulation of the patient.
I’ve been told that two people in a sleeping bag to treat
hypothermia is the “standard of care” in the wilderness.
Actually, it’s not. The science isn’t strongly in its
favor and in the wilderness our equipment is often less
than ideal and our need to improvise real. As always,
we’ll use our judgment, understand the principles of
treatment and weigh the factors in our specific scenario.
The heat sources you have available on your
wilderness trip may only be insulated hot water bottles
or the patient’s metabolism and shivering. If you have
a good camp and plenty of people, you may be able to
spare a person to be in the sleeping bag. If you’re a
small group, and knowing heat transfer between bodies
is not very efficient, you may decide your assistant
is best used starting a fire, making a warm meal and
drink on the stove, setting up the camp or attending
to the other people on your trip.
ACCIDENTS HAPPEN.
GET READY.
MEDICINE IN
THE WILD
Elective for 3 rd and 4 th Year
Medical Students
April 7-May 2, 2008
Gila Wilderness, NM
Wilderness Medicine Institute,
NOLS Professional Training
and the Harvard Affiliated Emergency
Medicine Residency program team up
to offer this truly unique elective.
You'll train in:
• Wilderness and expeditionary medicine
• Effective leadership and communication
• Backcountry travel and living
• Fundamentals of medical teaching
THIS IS THE ULTIMATE NOLS EXPERIENCE!
For more information please contact
NOLS Professional Training at
(800) 710-NOLS x 3, or visit us online:
www.nols.edu/wmi/courses/medicine
inthewild.shtml
If you spend any time in remote locations, you need wilderness medicine training. For 17
years, the Wilderness Medicine Institute of NOLS (WMI) has defined the standards in
wilderness medicine training. With a wide range of course and certification opportunities,
our graduates head into the backcountry prepared to act with confidence, make complex
decisions and manage emergencies. To find a course near you, contact:
THE WILDERNESS MEDICINE INSTITUTE OF NOLS
www.nols.edu/wmi • (866) 831-9001