[:en] Question and Answer Column About Hypothermia with dr. Titis Nurmasitoh, M.Sc,[:]

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dr. Titis Nurmasitoh, M.Sc, Permanent Lecturer in the Department of Physiology, Faculty of Medicine Universitas Islam Indonesia (FK UII)

What is meant by hypothermia?

Hypothermia is a condition in which the body temperature drops below 35⁰ Celsius or below the normal temperature required by metabolism and normal body function. If the body temperature drops below normal (below 35⁰C) then the metabolism and condition of the body (especially the muscles and brain) cannot function normally. Normal body temperature is 36,5⁰-37,5⁰ Celsius. Hypothermia conditions can occur or be experienced in various circumstances, including during climbing.

How does hypothermia occur in mountain climbers?

In general, hypothermia on climbing can be caused by cold temperatures, wet conditions, and wind that accompanies cold air. Cold temperatures are common in climbing, including mountains in Indonesia, which have a tropical climate. The condition of a wet climber's clothing can reduce the protective function of underwear in preventing the loss of heat from the body. Wet conditions can be caused by rain or storms that often come suddenly on the mountain. The wind that accompanies cold air is also common in the mountains. This condition will increase the loss of heat from the body which is directly exposed to the wind, especially when the clothes are wet. The combination of 2 or all three of these conditions has the potential to cause a person to experience hypothermia on climbing. The situation will get worse if the climber's condition is not good physically. The fatigue factor can also potentially cause a person to experience hypothermia. Fatigue can be caused by traveling too far, too fast, too heavy a burden, starvation, or a lack of protection against heat loss (eg clothing that is too thin or insufficient to protect the body).

Who has the potential to experience hypothermia while climbing?

People who hike with minimum preparation are at high risk of experiencing hypothermia. Climbers who are exhausted for various reasons also have the potential to experience hypothermia, especially if food intake (supplies) is also insufficient. Therefore, climbers must pay attention to the preparation before climbing (adequate clothing, sufficient food supplies, and proportional division of tasks and burdens in climbing groups). In addition, it is better for climbers to pay attention and seek information about weather conditions and the route to be taken during the climb.

What work does the body do when the temperature drops?

Normally, if the body temperature decreases from the normal range (36.5⁰-37.5⁰ Celsius) then the body has a natural effort to return the body temperature to the normal range. The way the body does this is by the onset of the shivering reflex. Shivering generates heat which is used to bring body temperature back to normal. In addition, the small blood vessels constrict (constrict) to prevent heat loss from the body. As a result of this constriction process, we often see the face, hands and feet become paler when cold occurs. Another attempt made by the body is the establishment of hair on the surface of the body to prevent the loss of heat from the body. If the business goes well (of course supported by other external factors) then the temperature range will return to normal. However, if the effort fails for various reasons, then a person will fall into a hypothermic state. Even more so when exposed to cold temperatures, wet conditions, and wind hitting the body continuously. This is exacerbated by the lack of body energy intake.

What are the signs that someone is experiencing hypothermia?

Symptoms of hypothermia vary widely and depend on how low the temperature is and how the initial conditions are in the patient's body. Early signs of hypothermia include: feeling cold, shivering to the point that the teeth are chattering, feeling tired, weak, speech starting to get muddled, footsteps slowing down, difficulty walking on uneven ground, mental and physical and coordination showing symptoms of decline. These symptoms will get worse if the patient's body and clothes are wet. If the condition gets worse, you will find symptoms such as decreased consciousness and increased respiratory rate and pulse. At this stage, conditions or awareness are often found that are contrary to reality. Sufferers may be indifferent to the cold they experience, their jackets are opened and their gloves removed (paradoxical feeling of warmth). The most dangerous condition is when a condition is encountered where the body is actually unable to shiver anymore after previously shivering violently. In this condition, the muscle glycogen (a source of energy) that is burned is insufficient to fight the decreasing temperature. As a result, the body stops shivering to maintain glucose reserves for the needs of other vital organs (eg the brain). The muscles begin to stiffen because blood flow to the surface of the body decreases, also caused by an increase in the formation of lactic acid and carbon dioxide in the muscles. In this condition, hallucinations may occur and be followed by a decrease in pulse rate and respiratory rate.

An easy introduction to increase awareness of hypothermia cases can be observed from the signs and symptoms known as "UMBLES" (grumbles, fumbles, mumbles, stumbles, and tumbles). Grumbles are signs where a person often complains, gets angry, or has a temper. Fumbles are a sign that a person has impaired coordination in both the eyes and the hands and feet. Mumbles is a sign that a person speaks less or speaks but is not clear. Stumblbes is a condition in which a person walks aimlessly and has no clear purpose. Tumbles is a condition in which a person falls for no apparent reason.

What should be done to prevent hypothermia?

The climbers should make sufficient preparations before starting the climb. We must prepare equipment and clothing that protects from cold, wet, and wind exposure from head to toe in accordance with climbing procedures, for example: waterproof jackets that can withstand cold exposure, field pants that dry easily, sleeping bags, socks, sarongs waterproof gloves, and a raincoat. The use of jeans is not recommended because jeans will be difficult to dry when exposed to wet. Headgear and closed shoes must also be prepared. The use of closed shoes is also recommended, not mountain sandals or flip-flops. Also make sure the climbers are warm (not cold or wet) while sleeping. Cover the bed with a mattress or use a sleeping bag.

Hikers should avoid direct contact with water. If it rains (even if it's just a light rain), the raincoat that has been prepared is immediately put on to protect the clothes from getting wet. It's best not to wait until it's raining heavily to wear a raincoat. Wet clothes are one of the factors that cause a decrease in body temperature. If the clothes are already wet, you should immediately replace them with dry clothes.

Hikers should consume enough food sources of energy before and during the trip. It is recommended to bring food that the body can quickly burn as calories, such as: brown sugar, chocolate, peanut butter, and so on. Adequacy of drinking and drinking regularly must also be considered.

Before going on a trip, climbers should make physical preparation by exercising regularly and measurably. Regular and measurable exercise will improve fitness and of course increase the body's resistance to various conditions. The journey taken should also be adjusted to the body's ability, body fitness, and how much the body has trained beforehand. For this reason, knowledge of the terrain and condition of each body is needed.

Even though the weather in the mountains tends to fluctuate, you should not climb when the weather is unfriendly or when there is high rainfall. Before the trip begins, it would be better if you plan the route to be taken along with the forecast of the weather conditions you will encounter.

Prepare mentally to take all conditions with adequate knowledge. If unexpected conditions occur or one of the climbing members shows symptoms of hypothermia, immediately change the itinerary or make it safer to return or change the safest route.

However, prevention is much better than causing casualties or having to deal with someone falling into a hypothermic state.

What should be done in case of hypothermia?

The basic principle of treating hypothermia is to restore the patient's body temperature by keeping the patient from losing heat and providing energy intake that has been used so that the body can regain energy or heat. Immediately seek the nearest shelter or help to protect sufferers from wind, rain and cold air. If it is not possible to find shelter, stop traveling temporarily and prepare a safe place to provide first aid to sufferers. If the patient's clothing gets wet, carefully change into dry clothes and provide extra clothing to help conserve heat.

If the patient is conscious, give warm drinks (eg chocolate or warm tea) to help restore lost body temperature. Also provide foods that are high in calories and easy to digest (eg cereal, warm soup, and so on). Do not give alcohol. Help the sufferer to move (small exercise) so that the body produces maximum heat. Of course, this is done after the condition improves. However, don't let this movement make the sufferer too tired or sweaty. It is better not to try to continue the journey even though the patient looks better. Look for the fastest and safest route to return to the initial route of the ascent and seek further assistance.

If the patient is unconscious, put him in a sleeping bag, try to warm the patient as much as possible, put him in the recovery position, and try to seek help immediately. Keep monitoring his pulse and breathing and give every aid action to the patient carefully/gently. Do not give food or drink if the patient is unconscious. Furthermore, after arriving at the bottom, continue efforts to help more adequately by seeking medical assistance.

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