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Protection against cold in prehospital care: wet clothing removal or addition of a vapor barrier

Henriksson, Otto; Lundgren, Peter J.; Kuklane, Kalev LU ; Holmér, Ingvar LU ; Giesbrecht, Gordon G.; Naredi, Peter and Bjornstig, Ulf (2015) In Wilderness & Environmental Medicine 26(1). p.11-20
Abstract
Objective



The purpose of this study was to evaluate the effect of wet clothing removal or the addition of a vapor barrier in shivering subjects exposed to a cold environment with only limited insulation available.



Methods



Volunteer subjects (n = 8) wearing wet clothing were positioned on a spineboard in a climatic chamber (–18.5°C) and subjected to an initial 20 minutes of cooling followed by 30 minutes of 4 different insulation interventions in a crossover design: 1) 1 woolen blanket; 2) vapor barrier plus 1 woolen blanket; 3) wet clothing removal plus 1 woolen blanket; or 4) 2 woolen blankets. Metabolic rate, core body temperature, skin temperature, and heart rate were continuously... (More)
Objective



The purpose of this study was to evaluate the effect of wet clothing removal or the addition of a vapor barrier in shivering subjects exposed to a cold environment with only limited insulation available.



Methods



Volunteer subjects (n = 8) wearing wet clothing were positioned on a spineboard in a climatic chamber (–18.5°C) and subjected to an initial 20 minutes of cooling followed by 30 minutes of 4 different insulation interventions in a crossover design: 1) 1 woolen blanket; 2) vapor barrier plus 1 woolen blanket; 3) wet clothing removal plus 1 woolen blanket; or 4) 2 woolen blankets. Metabolic rate, core body temperature, skin temperature, and heart rate were continuously monitored, and cold discomfort was evaluated at 5-minute intervals.



Results



Wet clothing removal or the addition of a vapor barrier significantly reduced metabolic rate (mean difference ± SE; 14 ± 4.7 W/m2) and increased skin temperature rewarming (1.0° ± 0.2°C). Increasing the insulation rendered a similar effect. There were, however, no significant differences in core body temperature or heart rate among any of the conditions. Cold discomfort (median; interquartile range) was significantly lower with the addition of a vapor barrier (4; 2–4.75) and with 2 woolen blankets (3.5; 1.5–4) compared with 1 woolen blanket alone (5; 3.25–6).



Conclusions



In protracted rescue scenarios in cold environments with only limited insulation available, wet clothing removal or the use of a vapor barrier is advocated to limit the need for shivering thermogenesis and improve the patient’s condition on admission to the emergency department. (Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
hypothermia heat loss thermal insulation emergency medical services
in
Wilderness & Environmental Medicine
volume
26
issue
1
pages
11 - 20
publisher
Elsevier
external identifiers
  • pmid:25712295
  • wos:000350268800003
  • scopus:84924024974
ISSN
1080-6032
DOI
10.1016/j.wem.2014.07.001
language
English
LU publication?
yes
id
1a4541c3-ed2c-4458-9408-96a0e88a2d86 (old id 5092629)
date added to LUP
2015-02-24 10:56:51
date last changed
2017-06-11 03:58:04
@article{1a4541c3-ed2c-4458-9408-96a0e88a2d86,
  abstract     = {Objective<br/><br>
<br/><br>
The purpose of this study was to evaluate the effect of wet clothing removal or the addition of a vapor barrier in shivering subjects exposed to a cold environment with only limited insulation available.<br/><br>
<br/><br>
Methods<br/><br>
<br/><br>
Volunteer subjects (n = 8) wearing wet clothing were positioned on a spineboard in a climatic chamber (–18.5°C) and subjected to an initial 20 minutes of cooling followed by 30 minutes of 4 different insulation interventions in a crossover design: 1) 1 woolen blanket; 2) vapor barrier plus 1 woolen blanket; 3) wet clothing removal plus 1 woolen blanket; or 4) 2 woolen blankets. Metabolic rate, core body temperature, skin temperature, and heart rate were continuously monitored, and cold discomfort was evaluated at 5-minute intervals.<br/><br>
<br/><br>
Results<br/><br>
<br/><br>
Wet clothing removal or the addition of a vapor barrier significantly reduced metabolic rate (mean difference ± SE; 14 ± 4.7 W/m2) and increased skin temperature rewarming (1.0° ± 0.2°C). Increasing the insulation rendered a similar effect. There were, however, no significant differences in core body temperature or heart rate among any of the conditions. Cold discomfort (median; interquartile range) was significantly lower with the addition of a vapor barrier (4; 2–4.75) and with 2 woolen blankets (3.5; 1.5–4) compared with 1 woolen blanket alone (5; 3.25–6).<br/><br>
<br/><br>
Conclusions<br/><br>
<br/><br>
In protracted rescue scenarios in cold environments with only limited insulation available, wet clothing removal or the use of a vapor barrier is advocated to limit the need for shivering thermogenesis and improve the patient’s condition on admission to the emergency department.},
  author       = {Henriksson, Otto and Lundgren, Peter J. and Kuklane, Kalev and Holmér, Ingvar and Giesbrecht, Gordon G. and Naredi, Peter and Bjornstig, Ulf},
  issn         = {1080-6032},
  keyword      = {hypothermia heat loss thermal insulation emergency medical services},
  language     = {eng},
  number       = {1},
  pages        = {11--20},
  publisher    = {Elsevier},
  series       = {Wilderness & Environmental Medicine},
  title        = {Protection against cold in prehospital care: wet clothing removal or addition of a vapor barrier},
  url          = {http://dx.doi.org/10.1016/j.wem.2014.07.001},
  volume       = {26},
  year         = {2015},
}