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scriptmedic
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@caramelmacheteasked:
My main character and his friend are caught in a snow storm in the back country of the Rocky Mountains. Average day time temp is 26 F and nighttime low is -8 F.  They have the best gear and clothes. What would the progression of hypothermia look like? What about frost bite? Once they get rescued, what would the first responders do, and the ER at the hospital? I don’t want to permanently injure either character, just set up a interesting scenario for hurt/comfort and angst that I haven’t personally read in this particular fandom yet. I can have them rescued as quickly as necessary to prevent long term damage. MC is going to have a sprained knee so they can’t just hike out. Thanks!

Hey there! Thanks for your ask. 

The Temps & The Stuff

Honestly, 26F over -8F (-3C to -22C) is a pretty survivable temperature range for a pair that sound experienced and well-prepared. Remember that people routinely summit Mt. McKinley in Denali National Park, which has the current weather conditions of -6F (both high and low) with wind chills of -35 (which might as well be F or C; they cross over at -40). [Source

The question of gear and environment are partially a question of expectation: were they expecting temperatures this cold? For example, it’s [very easy] to find sleeping bags that will keep a character comfortable in temps of -20F/-29C. 

You may want to under-prepare them a little, or have a storm crop up for which they aren’t prepared, or have some turn of events where they’re likely to get colder than they expected.

The Frostnibbles

You can have frostbite without hypothermia and hypothermia without frostbite. They’re related, but different, conditions. 

Frostbite is acute cold of a distal extremity, usually the hands, fingers, toes, feet, cheeks, and nose. It’s essentially that piece of tissue that’s been exposed, freezing. It causes severe local damage including necrosis (death of tissue) at severe stages. 

However, if the character bundles up well, you can have them get generally cold (hypothermia) without getting any one part specifically too cold (frostbite). 

As for hypothermia? Here’s an excellent chart:

image

The first mission of the Search and Rescue (SAR) team is to locate them and evacuate them. This is often done by helichopter, but snowmobiles might work in some areas. 

They won’t really be able to do much in the rescue vehicle. Keep the environment warm and administer warm packs to the groin and neck. They may administer warmed IV fluids if the character is severely hypothermic. 

In the ER, they’ll get a complete workup including rectal temperature. (It’s the only real temperature we have. Yes, we know it’s awkward. We’re doing it anyway.) They’ll get changed into hospital clothing and covered with warmed blankets. (Almost every ER  has these, and those that take flown-in SAR patients definitely have these).

Warmed IV fluids can be given, and distal body parts with suspected frostnip or frostbite will be immersed in warmed (105*F) water, and the water occasionally stirred. Warming up will hurt like the ending of worlds; imagine pins and needles to the most extreme degree and spread it along a large part of the body, and that’s how rewarming might feel. 

Once they’re treated for the hypothermia, they’ll be treated for the sprain, and they’ll move on with their lives. They might be kept overnight for observation, and if there’s dead tissue (necrosis) due to frostbite, they’ll be admitted for longer in order to have surgery to get rid of it. 

Hope this helped!! 

xoxo, Aunt Scripty

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