What first aid steps should you take for someone who faints after being injured in the cold rain?

Question

So let's say a friend has been outside exercising pretty intensely (eg. running) and they are caught in the rain. They have slipped and got impact trauma to their body and head but no broken bones. Their clothing is drenched from rain. You have managed to locate them but after making it to shelter the friend faints/loses consciousness and it's up to you to make sure they are ok. I would imagine the fainting could be either from fatigue, the injuries, cold or a combination of both? Temperature wise, it is Summer around +20-25C although due to the rainy weather it would be less than this. There isn't a significant amount of wind. They are wearing a single layer of casual clothes (that you would go jogging in) that is not water resistant.

Signs & Symptoms before and after:

• Some tiredness from the intense exercise
• Some pain from the trauma caused by slipping
• Some shivering from the coldness (rain & wet clothes)

Things not available:

• Building a fire (due to type of shelter)
• Sleeping bag (neither of us have one)
• Medical personnel/clinics

Things available:

• Blankets
• Towels
• Basic first aid kit
• Kettle, water, cups, bowls

My first instinct would be the removal of the friend's wet clothes, but let's say for arguments sake that this is not something you are comfortable doing. Happy for comments on this but please include alternative also.

What steps should you take to make sure they wake and don't get worse?

Answer 1

Note that I am a student of wilderness first aid, not a teacher. However, what you describe sounds like a serious life or death situation and not a time to worry about social norms. I advise you, and everyone else, to also get some training.

The following --which happens after you have both reached shelter and immediately the patient has lost consciousness-- are some very important initial steps to do in the first two minutes or so:

• Check that the airway is clear and that the patient is breathing. You may need to to remove food/vomit/tongue. You may need to perform CPR (chest compressions).
• Check for deadly bleeding. While this can be informed by knowledge of the injury and the subsequent journey back to shelter, it is possible there is bleeding in a hidden part of the body. You may need to apply direct pressure to stop bleeding.
• Treat for shock. Your patient is most likely in a state of shock. I don't mean "is surprised"; I do mean there is something dangerously wrong with the blood circulation. You must protect them from the elements --the cold and the wet-- as much as possible.

Because your patient is unconscious, has had an accident, and is losing body heat from the cold and wet, you must consider this as a serious case. It can be life-threatening.

There are many subsequent steps to be taken:

• Monitor the patient's vital signs --breathing, heart-rate, temperature, and level of consciousness-- as best you can.
• Continue to treat for shock. Remove wet clothes. Cover in dry blankets. Keep insulated from cold ground/floor. Keep in a recovery position (aka, drainage position) if they are still unconscious, or, if conscious, a comfortable position (eg, lying/reclining).
• • If you're worried about removing wet clothes, consider that the more the material is in contact with the body, and the wetter the material, and the more of it that is made from plant fibers, then the greater the evaporative cooling and hence the greater the danger of severe (ie, deadly) hypothermia.
• • If the person remains unconscious, i don't think there is anything you can do to "wake them up" other than continue to keep them in a safe, horizontal position and continue to keep them warm and dry.
• • If you really need more help on those two points you should do separate research on "dangers of cotton clothing", on "severe hypothermia", and on "drainage (or recovery) position".
• Make plans as to how you will get help. (I did assume you two were alone and you had no phone contact with emergency services.)
• Attempt to slowly rewarm the patient. Heat water, not too hot, place in bottles, insulate the bottles with thick socks or towels, and place them in the patient's armpits.
• Record information about prior injuries or illnesses, allergies and medications, changes in vital signs.
• Do not administer any food or drinks (warm or otherwise) unless the patient has made significant progress and, in your opinion, is definitely not going to need surgery.

The details and extent of what you should do will depend so much on the circumstances at hand: How does the patient respond to what you've done so far? What are the other details of the situation you're in?

Answer 2

Send someone to get help, even if it's hours away. The casualty's life may depend on it.

Someone needs to grab a phone and start walking. They should check periodically for signal, including at every high point.

I'd say it's unlikely they've passed out because of hypothermia, in the conditions you describe and consider the head injury to be serious. Intracranial Haematoma (bleeding on the brain) is life-threatening, not realistic to treat as a first aider, and has the very relevant symptom of progressive loss of consciousness. It's very compatible with loss of consciousness some time after a fall and blow to the head, such as after reaching shelter.

You still need to get/keep them warm, protect the airway (vomit is a real threat) and not make things worse. In the absence of any evidence of spinal injury, for the sake of maintaining the airway, put them in the recovery position with the head wound downwards (this may may help a little to relieve pressure build-up by allowing the wound to drain, but probably won't do much).

Another concern is blood loss. If they've been bleeding in the rain for some time they could have lost quite a lot. By the time they've reached shelter, they're unlikely to be in the process of bleeding out - either bleeding has slowed a lot or it's already too late. Again, if blood loss has led (or contributed) to loss of consciousness, you need professional help.

They could, of course, have been hypothermic for a long time if conditions were only a little worse than you say and they were hypothermic before they fell. In the Gansu Ultramarathon disaster earlier this year, runners set off with little or no warm gear climbing into bad weather. In a similar situation you may well have come across a casualty who has descended to warmer temperatures and reduced wind chill before succumbing to hypothermia and falling because of the resulting clumsiness. This means the hypothermia is more severe than I said above - but they still show signs of a head injury, and the care they need is still the same.

Thin synthetic exercise type clothes are far less of an issue than if they were caught out wearing lots of absorbent cotton. It may well be reasonable in the conditions you describe to leave the clothes. Once they're out of the weather, it's not that cold and they should rewarm easily. If we assume plentiful towels/blankets, you might wrap them in two layers, then try to get the wet inner layer out without uncovering too much. As you have access to water-heating, you can try to improvise hot- (or rather warm-) water bottles to provide gentle rewarming - ideally you'd warm the air but some heat tucked under a blanket near them will be of some use. Another person under the blankets with them is a good source of heat, even keeping a layer between you.

You imply that you've gone looking for someone missing in bad weather with "You have managed to locate them...". Doing this solo isn't a good idea, but you may not have much option. Doing this solo, without leaving word of what you're doing means you've neglected the first point in dealing with emergency situations: don't make the situation worse by putting yourself in danger. Of course there are limited situations in which this might not be the case, accidental separation from a hiking/running partner, but they don't fit your description very well. It's quite likely you should have alerted someone (mountain rescue via the police would be likely where I am) before going looking.

If it's just you and the casualty, I mainly offer sympathy - the decision of whether to leave them and get help, or stay with them and hope someone finds you soon is a very difficult one. Carrying a casualty is extremely strenuous, risky for both of you, and slow. It's not always impossible but is unlikely to be a good option.

Answer 3

What you are missing here is that just because you don't know enough to deal with the entire situation doesn't mean you can't deal with the parts of it you can address.

Unconscious without explanation--serious, but I would have no idea of treatment.

Hypothermia--the wet clothes come off. The inability to address the unconsciousness has no relevance to this decision.