Severe accidental hypothermiaBMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g1675 (Published 21 February 2014) Cite this as: BMJ 2014;348:g1675
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We have read with great interest the editorial titled “Severe accidental hypothermia”. The authors discussed key aspects of accidental hypothermia management, taking into consideration certain controversial issues and current trends. We found the concept of development and implementation of the hypothermia treatment algorithm particularly interesting.
It turns out that the protocol we have created and implemented is almost entirely consistent with the trends described in the paper published by Gordon et al. In July 2013, we created the Centre of Severe Hypothermia Treatment in Cracow which provides care in the region of Malopolska Province (area of 15,100 square kilometres, population of 3.3 million). The Centre operation is based on experience and medical equipment of the Department of Anaesthesiology and Intensive Care as well as the Department of Cardiovascular Surgery at Collegium Medicum Jagiellonian University, John Paul II Hospital.
We initiated a large media campaign aimed at both healthcare professionals and citizens. We prepared educational materials, such as multimedia presentations, and made them available at a special website of the Centre of Severe Hypothermia Treatment.
A key factor of effective operation was creating a position of a coordinator who is available at a 24-hour emergency telephone number. The coordinator is responsible for consultations regarding hypothermia cases recognised in the province area, assistance with treatment methods and potential qualification for extracorporeal rewarming.
The educational materials and the emergency number of coordinator for extracorporeal life support in severe hypothermia were provided to all emergency departments, ambulance service units, fire service units, Railway Protection Guard units, guards in 6 national parks, border guards and police units.
We initiated formal cooperation with 4 regional mountain rescue service groups. The scope of this cooperation includes notifying the coordinator of all search and rescue operations in order to improve medical care provided to victims who may be affected by hypothermia.
All (115 ambulances) medical emergency teams in the province were informed about the Centre and the potential for extracorporeal rewarming in the case of hypothermia. We created a special application that is linked to the notification and management system of medical emergency teams which ensures automated print of records that qualify for extracorporeal life support when the clinical criteria of severe hypothermia are met. In the whole province, the same extracorporeal procedure eligibility card is obligatory.
The dispatch centre for emergency medical units in Malopolska Province employs adequately trained personnel and is provided with the emergency telephone number of the coordinator for extracorporeal life support in severe hypothermia.
We made efforts to complement and standardise the measurement equipment used by all units that cooperate with the Centre to ensure measurements of the core temperature as early as during the initial management.
Both HEMS helicopters that operate in the province have been equipped with low temperature thermometers and their crews have been trained for hypothermic patient transportation.
We began cooperation with the Malopolska Province Crisis Management Centre personnel to implement a special procedure in the case of a large number of victims affected by severe hypothermia.
The provincial emergency medicine consultant has issued a following official guidance meant for the personnel of hospital emergency departments: “As part of emergency treatment, a core temperature measurement in unconscious patients with a history suggestive of hypothermia is obligatory. When a temperature below 28 degrees is detected, a telephone consultation with the coordinator for extracorporeal life support in severe hypothermia is recommended.”
The provincial family medicine consultant informs family doctors in the region of Malopolska Province about the problem of urban hypothermia and the methods of hypothermia treatment with a special emphasis on the severe hypothermia issue.
As a result of the efforts and cooperation with many self-government and emergency units at the basic life support and the specialist medical care levels, an effective notification system, which identifies patients with severe hypothermia, has been created.
Since 29 July, the coordinator for extracorporeal life support in severe hypothermia has provided consultations for 9 patients and received 3 notifications of search and rescue procedures. The criteria of extracorporeal life support in severe hypothermia were met by 3 patients (average - 63 years old) who qualified for arterio-venous ECMO. Treatment resulted in complete stabilisation of the cardiovascular and respiratory systems and complete recovery of neurological function – GCS 15 points.
As a consequence of our efforts, the Malopolska Province citizens can feel safe. The medical staff is provided with clear guidelines and the coordinator’s emergency number which will help qualify patients for extracorporeal life support in severe hypothermia. Although the implemented system has proved to be effective, it is still modified. We hope it can be the basis for a countrywide protocol in the future.
Tomasz Darocha 1,2, Sylweriusz Kosiński 3, Robert Galazkowski 2,4, Rafal Drwila 1, Anna Jarosz 1, Jerzy Sadowski 5
1 Department of Anesthesiology and Intensive Care, John Paul II Hospital, Cracow, Poland
2 Polish Medical Air Rescue
3 Department of Anesthesiology and Intensive Care, Pulmonary Hospital, Zakopane, Tatra Mountains Rescue Team, Poland
4 Department of Emergency Medicine, Medical University of Warsaw
5 Department of Cardiovascular Surgery & Transplantology, Institute of Cardiology, Collegium Medicum, Jagiellonian University, John Paul II Hospital, Cracow, Poland
Competing interests: No competing interests