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Death by hypothermia
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Author:  Allan Jacobs [ June 24th, 2018, 5:29 pm ]
Post subject:  Death by hypothermia

I have not experienced hypothermia and neither has anyone known to me.

Source 1 gives: Contrary to popular opinion, freezing to death is not a pleasant way to die. It is so painful...
I don't expect that hypothermia is a great way to do, but my question concerns the pain.
On the other hand, sources
2 and
3 ... ine-ripley
make no mention of the pain.

Is source 1 correct and sources 2 and 3 wrong,
or the other way around,
or is there a middle ground?

Thanks for the assistance, Allan

Author:  recped [ June 24th, 2018, 7:55 pm ]
Post subject:  Re: Death by hypothermia

Everything I have read including much related to hypothermia while mountain climbing indicates that it's quite a pleasant way to go once you get past the initial stages.

Climbers on Everest are often found (the bodies that is) partially disrobed, gloves removed, climbing suits unzipped, hoods/hats removed.

The classic way to do yourself in is to go for a long walk in the cold, lie down in a snow bank and drift off to a sleep you never awaken from.

Author:  Stencil [ June 24th, 2018, 9:01 pm ]
Post subject:  Re: Death by hypothermia

I have experienced what your source calls the moderate stage.
Brought on by walking for many hours in a cold rain without rain gear.
I was shivering, nauseous and losing muscle control and the ability to think.
I got into a sleeping bag and a companion gave me a hot drink.
I was well again within an hour.
We didn't know what it was ---- this was many years ago.
Still, it might have ended badly if I had been alone.
The interesting thing is it doesn't have to be cold. All that is required
is for your body to lose heat to a critical point.

Author:  Sam82 [ June 24th, 2018, 9:12 pm ]
Post subject:  Re: Death by hypothermia

There was an older fellow on this forum who said you weren't a true paddler till you have had hypothermia. I can't remember his name. Met him about 10 years ago for a possible trip. I have not had hypothermia so I didn't make the cut... .

Author:  Allan Jacobs [ June 24th, 2018, 9:49 pm ]
Post subject:  Re: Death by hypothermia

That undressing when near death from hypothermia is called "paradoxical undressing".

The term describes the behavior among many victims of extreme hypothermia of peeling off most or all of their clothing, increasing heat loss. ... ine-ripley


In severe hypothermia, there may be paradoxical undressing, in which a person removes his or her clothing, as well as an increased risk of the heart stopping...
Twenty to fifty percent of hypothermia deaths are associated with paradoxical undressing. This typically occurs during moderate and severe hypothermia, as the person becomes disoriented, confused, and combative. They may begin discarding their clothing, which, in turn, increases the rate of heat loss.
Rescuers who are trained in mountain survival techniques are taught to expect this; however, people who die from hypothermia in urban environments are sometimes incorrectly assumed to have been subjected to sexual assault.

Symptoms of mild hypothermia may be vague, with sympathetic nervous system excitation (shivering, high blood pressure, fast heart rate, fast respiratory rate, and contraction of blood vessels). These are all physiological responses to preserve heat. Increased urine production due to cold, mental confusion, and hepatic dysfunction may also be present.

An apparent self-protective behaviour, known as "terminal burrowing", or "hide-and-die syndrome",occurs in the final stages of hypothermia. The afflicted will enter small, enclosed spaces, such as underneath beds or behind wardrobes. It is often associated with paradoxical undressing. Researchers in Germany claim this is "obviously an autonomous process of the brain stem, which is triggered in the final state of hypothermia and produces a primitive and burrowing-like behavior of protection, as seen in hibernating animals". This happens mostly in cases where temperature drops slowly.

Heat is lost much more quickly in water than in air. Thus, water temperatures that would be quite reasonable as outdoor air temperatures can lead to hypothermia in survivors, although this is not usually the direct clinical cause of death for those who are not rescued. A water temperature of 10 °C (50 °F) can lead to death in as little as one hour, and water temperatures near freezing can cause death in as little as 15 minutes. A notable example of this occurred during the sinking of the Titanic, when most people who entered the −2 °C (28 °F) water died in 15–30 minutes.

As a hypothermic person's heart rate may be very slow, prolonged feeling for a pulse could be required before detecting. In 2005, the American Heart Association recommended at least 30–45 seconds to verify the absence of a pulse before initiating CPR. Others recommend a 60-second check.

Appropriate clothing helps to prevent hypothermia. Synthetic and wool fabrics are superior to cotton as they provide better insulation when wet and dry. Some synthetic fabrics, such as polypropylene and polyester, are used in clothing designed to wick perspiration away from the body, such as liner socks and moisture-wicking undergarments. Clothing should be loose fitting, as tight clothing reduces the circulation of warm blood.[48] In planning outdoor activity, prepare appropriately for possible cold weather. Those who drink alcohol before or during outdoor activity should ensure at least one sober person is present responsible for safety.

Covering the head is effective, but no more effective than covering any other part of the body. While common folklore says that people lose most of their heat through their heads, heat loss from the head is no more significant than that from other uncovered parts of the body. However, heat loss from the head is significant in infants, whose head is larger relative to the rest of the body than in adults. Several studies have shown that for uncovered infants, lined hats significantly reduce heat loss and thermal stress. Children have a larger surface area per unit mass, and other things being equal should have one more layer of clothing than adults in similar conditions, and the time they spend in cold environments should be limited. However children are often more active than adults, and may generate more heat. In both adults and children, overexertion causes sweating and thus increases heat loss.

Between 1995 and 2004 in the United States, an average of 1560 cold-related emergency department visits occurred per year and in the years 1999 to 2004, an average of 647 people died per year due to hypothermia.

In neither source did I see a reference to pain.

EDIT. I was told many times that the head was more responsible for heat loss than any other part of the body.
Another urban legend.

Author:  littleredcanoe [ June 25th, 2018, 7:37 am ]
Post subject:  Re: Death by hypothermia

The Head is responsible for a little more heat loss than is proportional to its surface area. About 10 percent of overall body heat loss but its seven percent the skin area. Anyone who has cut their head knows how vascular it is.

Getting any part of your body out of the water is important. Now the National Weather Service is issuing cold water warnings when the sun is out and the water temperature below 70 F (21C). It is directed toward paddlers and includes the warning to wear a PFD.

Author:  Splake [ June 25th, 2018, 9:03 am ]
Post subject:  Re: Death by hypothermia

I think it might have been Sk8tr who mentioned at some time that idea that the head was the greatest source of heat loss was a mis-communication of a particular research study - possibly US but I think it was definitely armed forces. If I recall correctly the finding in the study was that given the clothing the subjects were wearing in that particular study, then the greatest source of heat loss was the head. They may well not have been wearing hats at all.

That is consistent with what LRC stated. While the head can be a significant source of heat loss, when suitably protected it isn't a significantly larger source of heat loss than other body parts.

It looks like the definitions of the stages of hypothermia may have shifted a bit from when I was first taking first aid courses. My recollection was that the initial stage of hypothermia used to be defined by uncontrolled shivering. It looks like current definitions also require some degree of mental impact such as confusion or slurred speech. I'm not sure that is a good shift/change in the definition as it could give a false sense of non-urgency. It is important to start reacting to the situation before mental functions start being impacted.

Author:  wotrock [ June 25th, 2018, 7:16 pm ]
Post subject:  Re: Death by hypothermia

Splake wrote:

That is consistent with what LRC stated. While the head can be a significant source of heat loss, when suitably protected it isn't a significantly larger source of heat loss than other body parts.

I don't think that's what LRC is saying. I know from experience that, when I dunk my head while swimming in the summer, I cool of quickly. As Lrc pointed out, there are many blood vessels right in that thin layer of flesh on the head. Not only are the blood vessels more concentrated than elsewhere, but there is little if any fat----despite the moniker 'fat head' :D ---whereas most of us have a layer of fat on most parts of our bodies. I think that the study quoted above was a bit too 'sketchy' to draw any detailed conclusions.

Author:  jimdiane [ June 25th, 2018, 8:38 pm ]
Post subject:  Re: Death by hypothermia

Approximately 12 years ago a group of us hiked from the north rim of the Grand Canyon to the bottom,camped and hiked up the next day. The temperature at the base was very warm that morning on our assent, we all were dressed in shorts.............and it began to rain. Temp slowly dropped as we hiked and I felt very nauseous, and chilled but continued to hike, rain slowly turned to ice pellets and then snow. At one point all I wanted to do is stop and curl up on the ground and sleep, but thankfully my friends helped me to the end and 3 inches of snow on our vehicle was waiting for us. Hot liquids, warm van and blankets helped me recover slowly.............will never forget it

Author:  littleredcanoe [ June 26th, 2018, 7:51 am ]
Post subject:  Re: Death by hypothermia

I was taught that the head was the single greatest source of heat loss . Whether it was the majority I don't know but what stuck the most and is still accurate is that water with its high specific heat takes away heat 25 times faster than dry air. And the idea is get out of the water or get as much as you can out of the water.

Ive had hypothermia from hiking in a cold wet rain and a friend nearly died from a hike up Mt Washington where it rained and he did not have appropriate raingear. Thinking that Eastern Mountain hikes were just walks in the park ( he was from the Rockies) the abrupt change in weather got him.

And Jimdiane that must have been a surprise.. We did the same hike but it was quite warm and lemonade never tasted so good.

Curious if Environment Canada does cold weather warnings?

Author:  Splake [ June 26th, 2018, 10:39 am ]
Post subject:  Re: Death by hypothermia

I won't suggest that The Guardian is the best source of scientific info, but this article covers most of the background:

They traced the origins of the hat-wearing advice back to a US army survival manual from 1970 which strongly recommended covering the head when it is cold, since "40 to 45 percent of body heat" is lost from the head.


The myth is thought to have arisen through a flawed interpretation of a vaguely scientific experiment by the US military in the 1950s. In those studies, volunteers were dressed in Arctic survival suits and exposed to bitterly cold conditions. Because it was the only part of their bodies left uncovered, most of their heat was lost through their heads.

For the reasons already mentioned - limited if any insulating fat layer, lots of blood vessels - the head does lose a little more heat than another body area of similar size. However the idea that was long taught as fact - that the head is a major source of heat loss - was a misinterpretation of the actual research.

Putting it in the context of cold water exposure:

1) Yes getting out of the water is important
2) Getting into dry clothes is important
3) Since pants, shirts, coats cover a larger part of the body they are the most important items to get into quickly. If a hat is handy, grab it. If not, get that dry sweater on ASAP.
4) The body core - chest, abdomen - is going to be the most important to protect as it drives the blood flow and energy availability for the rest of the body.

Stepping back a level, if you simply think about getting out of the water after swimming in normal circumstances, drying off your body will cover a bigger area faster than drying your head first.

Of course none of this discussion really relates to the original question of what degree of pain is felt as hypothermia sets in and progresses.

Author:  burchil [ June 26th, 2018, 5:25 pm ]
Post subject:  Re: Death by hypothermia

Allan - I am glad to hear you have no experience with hypothermia. Your original question had to do with pain and from personal experience on more than one occasion I can say I didn't have pain. I was certainly cold to begin with, and pretty uncomfortable but no real pain. Fortunately I had no frozen parts - from observation that is where you absolutely get pain (esp when thawing).

I don't remember pain during recovery either but then I wasn't really focused on much.

Author:  nessmuk [ June 26th, 2018, 6:52 pm ]
Post subject:  Re: Death by hypothermia

I am a member of a search and rescue team, associated with the New York State Federation of SAR. As a veteran of many dozens of searches over the years, there have been several instances of paradoxical undressing. Particularly during fall hunting season, when it tends to be cooler, we are reminded during a search to look for clothing that a hypothermic lost person may have shed. Indeed we have found trails of clothing in the woods in some cases leading to both survivors and nonsurvivors. . Strange behavior.

Author:  Allan Jacobs [ June 26th, 2018, 7:02 pm ]
Post subject:  Re: Death by hypothermia

Burchill: Thanks!
I have never had hypothermia.
But I too know from personal experience that recovery from severe frostbite is painful.

Author:  red pine [ June 29th, 2018, 1:10 pm ]
Post subject:  Re: Death by hypothermia

Best source on hypothermia is Dr Gordon Giesbrecht who has done the most extensive research ever. Read this for the best info.
I read his first book years ago, the day after I fell through the ice . . . and waited 20 minutes for rescue. Wished I saw the book the day before!
FYI, in 20+ minutes of immersion, I felt no pain. It was cold of course, but not unbearably so. Perhaps due to layers wool. I even felt at peace. Not that I wanted to die, but that if I did, it would be OK.

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