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Major Ken Wishaw FANZCA
Royal Australian Army Medical Corps
Hypothermia
Awareness
Detection
Management
Complications of Mild 
Hypothermia (35°C)
 wound healing is delayed
 wound infections are increased threefold
 platelets do not work
 coagulation fails
 blood loss increases 30 ‐100%
 need for transfusion increases 30%
 Myocardial events  occur in 50%  with IHD
Core Temperature below   35.0o C 
quadruples mortality in severe trauma. 
Core Temperature below   35.0o C 
quadruples mortality in severe trauma. 
Is this a problem in Australia?
Core Temperature below   35.0o C 
quadruples mortality in severe trauma. 
Qld Trauma Registry
13% < 35°C
Core Temperature below   35.0o C 
quadruples mortality in severe trauma.
Qld Trauma Registry
Over half the cases happen after hospital 
admission.
ADF Anaesthesia Craft Group Position 
paper 
“Hypothermia and the Battle Casualty”
April 2010.
Why we don’t detect the 
problem
Heat distribution
vs  
environment temperature
Heat distribution
vs  
environment temperature
Redistribution Hypothermia
Hypovolaemic 
Shock 
Resuscitation 
Awake Anaesthesia
•Core temperature does NOT measure 
heat loss
•Peripheral temperature more reliable 
indicator
Hypothermia and the battle casualty  Wishaw
Detecting hypothermia
A F2010 H
Commonsense,  version 1.1.1
warm legs = warm heart
•Passive warming is minimally effective
•Warm cotton blankets do not work
•Active warming techniques must be
used
•Remove casualty from cold wet and windy environment.
•Remove and replace wet clothing.
•Insulate head and neck with beanie or balaclava if appropriate.
•Cover patient.
•Insulate underneath patient to protect from cold ground.
•Insulate underneath stretcher e.g. using camping mat or second
sleeping bag.
•Apply active warming devices if available.
•Warm IV fluids.
•Do not use ad hoc warming techniques directly against casualty’s
skin. This may result in burns.
Hypothermia and the battle casualty  Wishaw
NSN: 6515-01-532-8056
Cost: $93.00
Hypothermia and the battle casualty  Wishaw
Hypothermia and the battle casualty  Wishaw
Hypothermia and the battle casualty  Wishaw
Hypothermia and the battle casualty  Wishaw
Hypothermia and the battle casualty  Wishaw
Hypothermia and the battle casualty  Wishaw
Hypothermia and the battle casualty  Wishaw
Hypothermia and the battle casualty  Wishaw
Hypothermia and the battle casualty  Wishaw
Hypothermia and the battle casualty  Wishaw

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Hypothermia and the battle casualty Wishaw