 |
|
Hypothermia-Related Deaths—Utah, 2000, and United States, 1979-1998
Arch Dermatol. 2002;138:705-706.
HYPOTHERMIA IS a medical emergency that is completely preventable.1 Hypothermia occurs when persons are exposed to
ambient cold temperatures without appropriate protection for extended periods
of time.1 The clinical definition of hypothermia
is a core body temperature  95°F (35°C).1
This report describes cases of hypothermia-related deaths in Utah during 2000
and describes unintentional hypothermia-related deaths in the United States
during 1979-1998. The Utah cases illustrate risk factors and environmental
conditions associated with hypothermia.
Case Reports
Case 1
In February 2000, a man aged 50 years was found dead in an alley behind
local businesses in urban Utah. The high temperature that day had been 50°F
(10°C), and the low temperature had been 36°F (2°C) with 0.1 inch
of precipitation. The decedent was a transient who overused alcohol. His postmortem
blood alcohol level was 0.36 g/dL. The death certificate listed the cause
of death as hypothermia attributed to acute and chronic alcoholism.
Case 2
In March 2000, a man aged 27 years with a history of schizophrenia was
found dead in a remote area of Utah. An investigation determined that his
vehicle had become stuck in mud and he had become wet and cold while attempting
to extricate the vehicle. The death certificate listed the cause of death
as hypothermia.
Case 3
In October 2000, a boy aged 2 years was left alone by his father in
a vehicle in a remote area of Utah for approximately 45 minutes. When the
father returned, the child was missing. Six days later, the child was found
dead. During the 6 days the child was missing, snow and rain fell in the area.
The high temperature on the first day the child was missing was 54°F (12°C),
and the low temperature was 27°F (-3°C). The death certificate
listed the cause of death as hypothermia attributed to exposure to low environmental
temperatures.
Case 4
In December 2000, a woman aged 74 years with Alzheimer disease wandered
away from her nursing home in Utah. She was wearing her nightgown, was last
seen alive at 6:30 AM, and was found dead 3 hours later. The high temperature
that day was 15°F (-9°C), and the low temperature was -2°F
(-19°C) with snow on the ground. The death certificate listed the
cause of death as hypothermia attributed to exposure to low environmental
temperatures.
United States
U.S. data were obtained from the Compressed Mortality File (CMF), maintained
by CDC's National Center for Health Statistics, and were prepared in accordance
with the external cause-of-death codes from the International
Classification of Diseases, Ninth Revision (ICD-9). CMF contains information
from death certificates filed in the 50 states and the District of Columbia.
During 1979-1998, a total of 13,970 deaths were attributed to hypothermia
(ICD-9 codes E901.0, E901.8, and E901.9; excludes human-made cold E901.1).
The death rate attributed to hypothermia for males is approximately three
times that for females for every age group except for persons aged <15
years, and the elderly have the highest rates of death attributed to hypothermia.
During 1979-1998, Utah reported 91 deaths attributed to hypothermia,
with an age-adjusted rate of 0.4 per 100,000 population. During the same period,
Illinois reported the most deaths (859), with an age-adjusted rate of 0.4.
Alaska had the highest age-adjusted rate of 2.9, with 250 deaths attributed
to hypothermia.
Reported by:
TC Grey, MD, Office of the Medical Examiner, R Rolfs, MD, Acting State
Epidemiologist, Utah Dept of Health. MA Chambers, Western Regional Climate
Center, Reno, Nevada. AS Niskar, MPH, Div of Environmental Hazards and Health
Effects, National Center for Environmental Health, CDC.
Editorial Note:
The findings in this report indicate that hypothermia-related deaths
in the United States increase with age and that rates are highest among men.
In the cases presented in this report, all decedents had one or more risk
factors for hypothermia-related death (e.g., aged  65 years, alcohol use,
homelessness, and mental illness).
The warning signs of hypothermia include shivering, confusion and disorientation,
memory loss, drowsiness, exhaustion, fumbling hands and poor coordination,
slurred speech, and numbness.1-2
Shivering is a sign that the body is losing heat and shivering decreases as
body temperature falls; a person who shivers persistently should return indoors.
Severe hypothermia results in unconsciousness, shallow breathing, weak pulse,
and death. Warning signs of hypothermia in an infant in clude bright red,
cold skin and lethargy.
Persons with signs or symptoms of hypothermia should seek medical attention
immediately.2 Until medical care becomes
available, the person should be moved into a warm room or shelter and wet
clothing removed. The center of the body should be warmed first, including
the chest, neck, head, and groin using an electric blanket or skin-to-skin
contact under loose, dry layers of blankets, clothing, towels, or sheets.
Warm, nonalcoholic beverages can help increase body temperature, but they
should not be given to an unconscious person. If the person does not appear
to be breathing, does not have a pulse, and appears to be unconscious, cardiopulmonary
resuscitation (CPR) should be administered in conjunction with warming efforts
until the person responds or medical attention is available. Even if the person
appears to be dead, CPR should be provided because, in some cases, persons
with hypothermia who appear dead can be resuscitated.
Alcohol use, homelessness, vehicle breakdown, psychiatric disorders,
and Alzheimer disease are all risk factors associated with hypothermia. Factors
such as neuromuscular disease, arthritis, hypothyroidism, malnutrition, beta-blocker
use, neuroleptic use, and alcohol use decrease the body's ability to produce
heat.1, 3 Factors that
can result in increased body heat loss include psoriasis, dermatitis, burns,
dehydration, decreased subcutaneous fat, and alcohol use. Loss of body thermo-regulation
can occur with central nervous system pathology, trauma, stroke, Parkinson
disease, neuropathies, and spinal cord injuries. Elderly persons are more
likely to have one or more risk factors, placing them at especially high risk
for hypothermia. Children are particularly susceptible to hypothermia.4 Infants need sufficient blankets and clothing
for insulation.1 Persons participating
in outdoor activity might have impaired judgment from hypothermia, causing
them to remain unprotected in situations of dangerous cold.1, 5
An extremely cold environment is not necessary for hypothermia.1, 6 Persons who participate in
outdoor activities during cold weather should take precautions to avoid hypothermia.
Persons can maximize heat production by voluntary muscular activity, shivering,
eating to maintain calorie intake, and drinking nonalcoholic beverages to
stay hydrated. Heat loss can be minimized by wearing a hat that does not retain
moisture, a scarf or knit mask to cover the face and mouth, sleeves that are
snug at the wrist, mittens, water-resistant coat and shoes to stay dry, and
several layers of loose-fitting clothing.2, 6
The outer layer of clothing should be tightly woven and wind resistant to
reduce body heat loss caused by wind. Wool, silk, or polypropylene inner layers
of clothing will hold more body heat than cotton. Persons who feel too warm
should remove extra layers of clothing because excess perspiration will increase
heat loss. In high wind, use of goggles can protect the corneas from freezing.
Persons should avoid overexertion and overheating because of potential dehydration
and the wetting effect of perspiration. Swimmers need insulating swimwear
in cold water.
Vehicle-safety precautions also can help prevent hypothermia.1-2 Vehicles should be equipped
with cold weather gear for use during a breakdown. Travelers stranded during
a winter storm should remain in their vehicle, stay awake, and wrap their
entire bodies in extra clothing, blankets, or newspapers to stay warm. The
motor and heater should be run for approximately 10 minutes per hour and one
window should be opened slightly to let in air while making sure that snow
is not blocking the exhaust pipe to reduce the risk for carbon monoxide poisoning.
Persons should move their arms and legs to improve circulation and stay warmer,
and avoid eating unmelted snow because it will lower body temperature.
Public health prevention strategies for reducing hypothermia-related
deaths include educating the public and health-care providers about heat preservation
strategies and providing outreach programs that identify and protect persons
at risk (e.g., the elderly, young children, mentally and physically disabled
persons, persons with psychiatric disorders, and homeless persons).1 Community outreach programs should check on these
risk groups frequently to discourage prolonged exposure to cold and to ensure
properly heated dwellings. Many hypothermia-related deaths might only be prevented
with improvement in overall medical and social support services for vulnerable
populations. Public health prevention strategies for reducing hypothermia
should be part of a broader social support program to provide support services
to populations at risk.
MMWR. 2002;51:76-78.
1 figure omitted.
REFERENCES
|
1. Kilbourne EM. Cold environment. In: Noji Ek, ed. The Public Health Consequences of Disasters. New
York, New York: Oxford University Press, 1997:270-86.
2. CDC. Extreme cold: a prevention guide to promote your personal health and
safety. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC,
1996.
3. Ranhoff AH. Accidental hypothermia in the elderly. Int J Circumpolar Health. 2000;59:255-9.
PUBMED
4. Kozole A. Hypothermia in a 7-year-old boy: the Current Creek rescue. J Emerg Nurs. 1999;25:56-9.
PUBMED
5. Thein LA. Environmental conditions affecting the athlete. J Orthop Sports Phys Ther. 1995;21:158-71.
PUBMED
6. Sallis R, Chassay CM. Recognizing and treating common cold-induced injury in outdoor sports. Med Sci Sports Exerc. 1999;31:1367-73.
PUBMED
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter
What's this?
|
