[pct-l] going wet....

[calliger at infolane.com (Richard)]

....thousands??? I did not believe that number..but here is what google came
up with!! WOW!!

  	

Hypothermia-Related Deaths --- United States, 2003--2004

Hypothermia, a reduction in the body's core temperature to <95.0?F
(<35.0?C), is a preventable medical emergency usually caused by prolonged
exposure to cold temperatures without adequate protective clothing (1).
Warning signs and symptoms of hypothermia include lethargy, weakness and
loss of coordination, confusion, uncontrollable shivering, and reduced
respiratory or heart rate (2). Common risk factors are advanced age,
substance abuse, altered mental status, and increased contact with
substances that promote heat loss, such as water (3). This report describes
three hypothermia-related deaths that occurred in the United States during
2003--2004, summarizes hypothermia-related mortality during 1979--2002,
describes risk factors for and symptoms of hypothermia, and reviews measures
to prevent hypothermia-related injury and death. Public health strategies
tailored to persons at increased risk for exposure to excessive cold might
help reduce hypothermia-related morbidity and mortality.
Case Reports, 2003--2004

Case 1. In December 2003, a man aged 69 years with dementia was reported
missing from his residence in Vermont. Despite extensive searches, his body
was not found until March 2004 in the backyard of a nearby home. During that
period, outdoor temperatures ranged from -14?F to 57?F (-26?C to 14?C).
Descriptions and photographs of the scene suggested that the man had tried
to cover himself to keep warm. Cause of death was reported as hypothermia,
with dementia as a contributing factor.

Case 2. In February 2004, a male aged 16 years was found dead 40 yards from
a road in a rural park in northwestern New Mexico. He had last been seen
alive the previous day when he was dropped off at high school. The boy was
found wearing damp, light clothing; his jacket and neck chain were recovered
a short distance away. Temperatures in this region ranged from 11?F to 42?F
(-12?C to 6?C) on the day he was found. An autopsy identified minor
abrasions and contusions on his face and extremities. His blood alcohol
concentration (BAC) was 0.15 g/dL, nearly twice the state legal limit of
0.08 g/dL for drivers. Toxicologic analysis of blood and urine also revealed
2 ng/mL of delta-9-tetrahydrocannabinol (THC) and 50 ng/mL of
delta-9-carboxy-THC, both active ingredients in marijuana that suggest
recent or chronic marijuana use. The cause of death was certified as
hypothermia from cold exposure, with alcohol and marijuana intoxication as
contributing factors.

Case 3. In February 2004, a man aged 18 years was found dead near a creek in
southeastern Alaska. He was dressed lightly for winter conditions. The man
had been missing for approximately 1 day, during which temperatures had
ranged from 39?F to 45?F (4?C to 7?C). Toxicologic testing revealed a BAC of
0.18 g/dL, twice the state legal limit of 0.08 g/dL for drivers, and a urine
ethanol concentration of 0.28 g/dL. The cause of death was listed as
combined effects of alcohol intoxication and hypothermia.
Hypothermia-Related Mortality, 1979--2002

During 1979--2002, a total of 16,555 deaths in the United States, an average
of 689 per year (range: 417--1,021), were attributed to exposure to
excessive natural cold (International Classification of Diseases, Ninth and
Tenth Revision ICD-9 codes E901.0, E901.8, and E901.9; ICD-10 code X31)
(Figure 1) (4). Annual death rates were highest before 1990 (range: 0.3--0.4
per 100,000 population), then decreased to 0.2 beginning in 1991, except for
an increase to 0.3 in 2000.

In 2002, a total of 646 hypothermia-related deaths were reported, with an
annual death rate of 0.2 per 100,000 population. The majority of reported
hypothermia-related deaths (66%) occurred in males (Figure 2), but the
overall death rate (0.5) was the same for both males and females. Fifty-two
percent of all decedents were aged >65 years, and 50% were male. The death
rate for males and females aged >65 years was 1.2 and 0.8, respectively.
Forty-five percent of all reported deaths occurred among white males (death
rate: 0.3), and 14% occurred among black males (0.5).

States with the greatest overall death rates for hypothermia in 2002 were
Alaska (3.0), New Mexico (0.9), North Dakota (0.9), and Montana (0.8). In
addition, hypothermia-related deaths were reported by states with
characteristically milder climates that experience rapid temperature changes
(e.g., North Carolina [0.4] and South Carolina [0.4]) and by western states
that have high elevations and experience considerable changes in nighttime
temperatures (e.g., Arizona [0.3]).

Reported by: F Fallico, MD, Alaska Dept of Health and Social Svcs. K Nolte,
MD, Office of the Medical Investigator, Univ of New Mexico School of
Medicine, Albuquerque, New Mexico. L Siciliano, Vermont Dept of Health. Div
of Environmental Hazards and Health Effects, National Center for
Environmental Health; F Yip, PhD, EIS Officer, CDC.
Editorial Note:

All hypothermia-related deaths are preventable. Early recognition of the
signs and symptoms of hypothermia and awareness of key risk factors can help
minimize morbidity and mortality from exposure to extreme cold.

Hypothermia can be classified as mild (core body temperature: 90.0?F to
<95.0?F [32.2?C to <35.0?C]), moderate (82.5?F to <90.0?F [28.0?C to
<32.2?C]), or severe (<82.5?F [<28.0?C]) (5). Onset of hypothermia is not
always evident, although shivering, numbness, lethargy, poor coordination,
and slurred speech are typical early manifestations. Among infants, warning
signs also include bright red skin and low energy. When body temperature is
<90.0?F [<32.2?C], shivering might not be evident, and the victim might not
feel cold. In severe hypothermia, the victim loses consciousness, and a
pulse might not be apparent (6).

Understanding the risk factors for hypothermia can help identify populations
at risk. This report highlights three risk factors for hypothermia-related
deaths: advanced age (>65 years), mental impairment, and substance abuse.
Additional contributing factors can include homelessness, dehydration, and
serious medical conditions (2). Older persons are at particular risk because
their lower metabolic rate might prevent their maintaining normal body
temperatures when indoor or outdoor temperatures fall below 64.4?F (18.0?C)
(1). Older persons also might not perceive cold as well as younger persons
and might be slow to compensate for the cold. Hypothyroidism and diabetes
can contribute to hypothermia risk through decreased metabolic rate and
hypoglycemia, respectively (3). Substance abuse is another potential
contributor to hypothermia; alcohol and drug use (e.g., sedatives or
phenothiazines) can suppress vasoconstriction and the shivering response
through cutaneous vasodilation, alter decision-making, and decrease
awareness of and response to hazardous environmental conditions (3).

Immediate medical attention should be sought for persons who exhibit signs
of hypothermia. Wet clothing should be removed and further heat loss
prevented by warming the center of the body, using blankets for passive
rewarming. Although victims might appear dead, cardiopulmonary resuscitation
should be provided during warming until they respond or until medical aid
becomes available (6). Active rewarming, especially among persons with
moderate to severe hypothermia, typically involves administration of warmed
intravenous fluids or rewarming of the airways.

To prevent hypothermia-related deaths, public health strategies should
target persons at greatest risk. During cold periods, relatives, neighbors,
and caretakers of persons at high risk for hypothermia, particularly those
of advanced aged, should check frequently on their condition, familiarize
themselves with signs of hypothermia, and take appropriate preventive
action. Health departments in states characterized by milder winter climates
but rapid temperature changes should identify groups at high risk for
hypothermia, ensure that proper resources are available to them to minimize
exposure to cold, and maintain communication with them regarding preventive
measures.

Educating public safety personnel and hospital staff to better recognize
hypothermia victims and to familiarize themselves with initial treatments
also can help prevent hypothermia-related morbidity and mortality. Because
certain signs of hypothermia, such as confusion and loss of coordination,
can resemble alcohol intoxication, hypothermia victims might be sent to
detoxification centers before they are sent to hospitals. Workers at
detoxification centers should be aware of signs and risk factors for
hypothermia and be instructed to take the temperature of potential
hypothermia victims at admission (7).
References

   1. Kilbourne EM. Illness due to thermal extremes. In: Last JM, Wallace
RB, eds. Public health and preventative medicine. 13th ed. Norwalk, CT:
Appleton and Lange; 1992:63--8.
   2. CDC. Extreme cold: a prevention guide to promote your personal health
and safety. Atlanta, GA: US Department of Health and Human Services, CDC;
2004. Available at http://www.bt.cdc.gov/disasters/winter/guide.asp.
   3. Weinberg AD. Hypothermia. Ann Emerg Med 1993;22:370--7.
   4. National Center for Health Statistics. Compressed mortality file.
Hyattsville, MD: US Department of Health and Human Services, CDC, National
Center for Health Statistics; 2004.
   5. Lazar HL. The treatment of hypothermia. N Engl J Med 1997; 337:1545--7.
   6. Abramowicz M. Treatment of hypothermia. Med Lett Drugs Ther
1994;36(938):116--7.
   7. CDC. Exposure-related hypothermia deaths---District of Columbia,
1972--1982. MMWR 1982;31:669--71.



R

At 02:58 PM 10/11/2005 -0700, Brian McLaughlin wrote:
>----- Original Message -----
>
>> Not long ago, someone posted a theory of hiking in perrenial wet weather--
>> deliberately going 'wet'. The theory was something like, forget keeping
>out
>> the rain, find a way to tolerate wetness while hiking on the trail, then
>dry
>> off and keep dry the normal way in camp.
>
>The issue is seldom wetness. After all, your skin is waterproof.
>The issue is usually warmth, or the lack of it. Cold rain and
>wind are notorious for sucking warmth out of you. Hiking
>wet is perfectly acceptable as long as you don't leave yourself
>vulnerable to hypothermia from evaporative and convective
>cooling.
>
>In fact, many a hiker has hiked wet all day, even while wearing
>rain gear that was meant to keep them dry. Didn't kill them,
>either. OTOH, hypothermia has killed thousands of hikers.
>
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