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Cold weather care - Rx for the Arctic.

Less than 2 percent of Alaska's health care providers specialize in cold weather medicine, but their skill saves growing numbers of lives each year.

Jack London's story, "To Build a Fire," tells the tale of a man and his dog facing the rigors of travel in the Alaska wilderness. Inexperienced and ignorant of the rugged terrain's many dangers, the man falls through a thin sheet of ice covering a stream. He scrambles to build a fire and dry his clothing to prevent dying a frosty death. But as the fire flickers out, the dog watches the man die from the cold.

The outcome of that story could have been different if the traveler had learned more about what to bring on a trip and how to handle life-threatening situations that arise from sub-zero temperatures. In Alaska, emergency training has become a necessity and the rescue/medical community has assumed the responsibility of educating people before they are faced with a cold-weather crisis.

"Because the wilderness can basically begin in your back yard in Alaska, it is very important to be ready for any emergency," says wilderness emergency medical technician (EMT) Sandra Call of Emergency Medical Training of Alaska (EMTA). "You never know when a serious injury could take place. The weather does not have to be below zero for hypothermia to set in. If a person gets wet and their body temperature drops below 90 degrees, they are in danger of freezing in their core organs (heart, lungs, and brain). But when the weather is below zero, the proper training becomes even more important."

Hypothermia is described by Dr. Will Jackson, in Sea Kayaker magazine, as mild (core temperature above 90 degrees) or severe (core temperature below 90 degrees). The longer one is exposed to the cold without proper care, the greater the severity of the hypothermia. If the core temperature drops into the mild range, limbs will become progressively colder and will feel stiffer because muscle and nerve efficiency is decreased.

"In addition, shivering will be present and become uncontrollable in most cases, adding to poor manual dexterity," Call says. She describes people suffering from the loss of motor and mental skills as acting like "dumb sheep" or getting the "umbles" (stumbles, fumbles, grumbles and mumbles).

Call and her husband Scott, also a wilderness EMT, teach beginners that there is always some risk in any cold weather undertaking. Their classes, geared to form the basis for a "risk management" plan, include: knowing the correct nutritional and clothing needs; recognizing the warning signs of hypothermia and learning how to stabilize victims until they can be transported to a medical facility; caring for broken limbs; and mastering splinting techniques.

The Calls point out that what you eat is as important as the clothes you wear. You can compare your body with keeping a campfire or furnace burning. In order to function properly, the body, like the furnace or campfire, must be continually fueled to maintain normal body temperature. Eating foods that are high in carbohydrates and drinking fluids to keep your body hydrated will help sustain heat in your body core. Avoid alcoholic beverages, however, because the initial feeling of warmth it provides fades quickly, and lowers your body's ability to produce heat energy.

Brian Horner, owner and chief instructor of LTR Training Systems, bases his business on the premise that you can never be overtrained. He says his firm "offers a wide variety of realistic academic and field courses designed to present information to individuals who must work and live under potentially hazardous environmental conditions or who wish to increase their ability to respond to emergency situations."

LTR, the acronym for Learn To Return, started in 1986 with the goal of teaching industrial personnel and the military how to deal with emergency situations in Alaska's harsh environment. Program coordinator Bruce Birchell put together a course list that starts with "Welcome to Alaska! (An Arctic indoctrination)" and works up to "Ice Dive Rescue." Classrooms at LTR provide students with the actual equipment they will be using in rescue situations yet leave enough room to practice techniques under instructor supervision.

EMTA also uses the hands-on approach to getting their message across to the class. In addition to a lecture series and slide show, students learn to fashion slings for injured limbs from an article of clothing or a roll of duct tape. The class, divided into groups, practices sling techniques on subjects with only the items Sandra Call provides.

Both companies stress that because proper medical care can be a minimum of two hours away, students can only learn how to stabilize hypothermia and physical injuries until transportation arrives. The next step is in the hands of hospital treatment centers, such as the Providence Hospital Thermal Unit.

Bringing body temperatures back to normal is the priority when working on hypothermia and frostbite. The preferred method of warming the patient is with a whirlpool or warm water bath, but if the problem is serious, surgeons will perform a heart-lung bypass, taking the blood out of the body gradually, warming it, and putting it back into the patient's body.

"We basically finish on any thawing process," says Alexis Klapproth, thermal unit staff nurse at Providence Hospital and an Outreach program coordinator. "We like to consider first doing a rapid thaw so if a person came to us and was still frozen, we put it |the affected area~ in warm water -- warm water to us is somewhere between 95 degrees and 105 degrees -- and we thaw it |the affected area~ out."

Klapproth adds that as the body thaws, some pain is felt because the ice crystals start to break up and they tear at the inner flesh that was frozen. But there is limited shock, however, because the water is heated only enough to bring the patient near to normal body temperature.

The primary goal, though, is to maximize the body's circulation for healing ability. Proper circulation is achieved by using lukewarm whirlpools twice a day. Soap is used to prevent any kind of bacteria entering the damaged skin tissue and interfering with the healing process. Warm water helps to open blood vessels that were not totally damaged, creating a more healthy blood flow.

Sometimes a patient arrives at the unit with total-body cool down. Klapproth says that body temperatures are sometimes as low as 85 degrees. At this point, health personnel may administer warm intravenous fluid or help the patient breathe a warm air mist before giving warm water treatments. If there is no response to either method, then a heart-lung blood bypass is performed as the last resort.

Cold weather medical techniques, first aid, and rescue have become an imperative part of the Alaska wilderness adventure. Because today's visitor wants to get the total "Alaska experience" first hand, outdoor experts warn independent travelers to know where they are going and be aware of the potential dangers they may face before starting out on a trip.

Bruce Birchell of LTR says that a lot of Alaska destinations are backcountry, far from civilization -- and miles away from help. "In Alaska you can go 30 miles in a straight line from your starting point and the only place you have gone is 30 miles to nowhere," he says.

Like the character in Jack London's story, today's Alaska adventurers can face serious injury or death if they don't know the facts of cold-weather survival -- or if they don't have the assistance of Alaska's cold-weather medical specialists.
COPYRIGHT 1993 Alaska Business Publishing Company, Inc.
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1993 Gale, Cengage Learning. All rights reserved.

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Title Annotation:health care for cold weather ailments
Author:Berger, Michael
Publication:Alaska Business Monthly
Date:Jul 1, 1993
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