This article is part of the #STCPreventionMatters campaign from the R Adams Cowley Shock Trauma Center, University of Maryland. For more information about the campaign and the Center for Injury Prevention and Policy, visit www.umm.edu/PreventionMatters
An ambulance brought an elderly man to the University of Maryland Medical Center’s Emergency Department (ED) after he was found lying on a sidewalk. The temperature had dipped to 35 degrees on that winter night. No one knew how long the man had been exposed to the cold. At the scene, the EMS crew recorded his body temperature as 68 and couldn’t find a heartbeat. As they wheeled him into the ED, they gave him CPR, trying to save his life.
The ED team took over, giving him medications and shocks to try to restart his heart, circulating warmed air and pushing warmed fluids throughout his body to try to bring his temperature back to normal. His temperature started to rise toward 90 degrees, but the effects of the cold were too great. After hours of CPR and despite all of the team’s efforts to revive him, his heart would not restart. The cold had done too much damage.
Unfortunately, many people in Baltimore do not have access to shelter and warmth. This time of year forces them into a constant struggle for life and limb. At UMMC, there is an increase in the number of people coming to the ED with hypothermia and cold-related injuries such as frostbite and carbon monoxide poisoning.
Last winter, Maryland recorded 61 cold-weather deaths. Hundreds more people sustained cold-related injuries. Most of the people who die or are injured because of cold conditions are homeless, elderly, the very young or individuals with mental health illnesses. In the general population, emergencies related to the cold usually involve intoxication, participating in outdoor activities, or simply being outside without proper clothing for too long.
If someone who has been out in the cold begins to mumble, fumble or stumble (the “Umbles”), get them to a warm place and call 9-1-1. The Umbles are signs that the body is beginning to lose its capacity to warm itself. Hypothermia is defined as a body temperature below 95 degrees. In its first stage, from 90 to 95 degrees, the body attempts to warm itself by shivering, constricting blood vessels in the fingers and toes, and burning stored fat and carbohydrates. Once the Umbles set in, below 90 degrees, the heart rate begins to slow and irregularities in the heart’s rhythm start to appear.
In Baltimore, homeless shelters operate on “winter shelter conditions” when the temperature, including wind chill, falls below 32 degrees. On those days and nights, the shelters extend their capacities to accommodate the increased number of people in need of warm shelter. All of these shelters can be accessed by going to the Weinberg Housing and Resource Center on a day when winter shelter conditions are declared.
UMMC staff members make every effort to ensure that patients who are being discharged from the hospital have adequate shelter on cold days and nights. If patients do not have a warm place to go, access to shelters is arranged and transportation provided through a bus fare or a ride service. Staff members regularly access UMMC storage closets where clean clothes, shoes, and socks are available for patients in an emergency with inadequate clothing. Additionally, through the UMMC Project Engage campaign, the hospital provides health and social services to the homeless community of Baltimore, including food, medical, behavioral and housing resources.
What can you do to prevent cold-related injuries?
•If someone is showing signs of hypothermia, help them get the care they need and call 9-1-1.
•When you know you will be exposed to cold weather, protect yourself by wearing appropriate clothing.
•Dress in layers; you can always take clothes off, but you can’t put more on if you don’t have them.
•If you’re going out into the rain or falling snow, avoid cotton clothing because it doesn’t dry well and will stay wet longer than other fabrics.
Winter will be with us for several more weeks. Let’s be vigilant about preventing hypothermia in ourselves and about protecting the young, the old, and those who do not have access to warm shelter. We are all vulnerable to winter weather, and we can take common-sense precautions to protect ourselves and those around us.
The Weinberg Housing and Resource Center is located at 620 Fallsway, Baltimore, MD 21202. The phone number is 667-600-3230. It is open 24/7 and never closes for holidays or bad weather.
Dr. Nicholas Walter is a resident physician in the University of Maryland School of Medicine’s Department of Emergency Medicine. He is a former wilderness guide for the Outward Bound School and has specialty interests in wilderness and environmental medicine. Dr. Callahan serves as the Vice President of Population Health and Dr. Marcozzi is an Associate Professor of Emergency Medicine in the University of Maryland School of Medicine, Co-Director of the Program in Health Disparities and Population Health and the Assistant Chief Medical Officer for Acute Care at UMMC.