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Undersea Biomed Res, 4 1 , Leach, J. Andean high altitude diving expedition. Journal of Underwater Technology, 12, High altitude dives in the Nepali Himalaya. Undersea Hyperb Med, 21 4 , Lenihan, D. High Altitude Diving. Santa Fe, New Mexico: U. Department of the Interior. National Parks Service. Marroni, A. What ascent profile for the prevention of decompression sickness?

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II - A field model comparing Hill and Haldane ascent modalities, with an eye to the development of a bubble-safe decompression algorithm. Underwater Hyperb. Morris, R. Diving at extreme altitude: Dive planning and execution during the High Lakes Science Expedition. Diving for science and technology 4th ed.

Department of Commerce. National Oceanic and Atmospheric Administration.

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Paulev, P. High altitude diving depths. Research in sports medicine, 15, Sahni, T. High altitude dives from to 14, feet in the Himalayas. Undersea Biomed Res, 18 4 , Schrotter, H. Der sauerstoff in der prophylaxie und therapie der luftdruckerkrankungen 2nd ed.

Smith, C. Altitude procedures for the ocean diver pp. Wienke, B.

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Diving above sea level. Hypothermia is one of the biggest risks to your life at high altitude. Hypothermia is defined as a core temperature below 35 degrees. It is broadly categorised into:. Mild hypothermia degrees C. Moderate hypothermia degrees C. Onset of hypothermia in an individual depends on multiple factors both individual and environmental.

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Individual factors include fitness, food intake, clothing, injury and illness. It is important to remember it can occur at modest temperatures when there is prolonged exposure to water, driving rain or wind chill. If an individual develops one condition the others should be sought and if one member of a group develops hypothermia the whole group should be checked. Normally thermoregulation within the body balances heat loss into the environment with heat production by the body organs and muscles.

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This is important as the body's enzyme systems only function within a narrow range of temperature around 37degrees C. In mild hypothermia this process is still active producing voluntary and involuntary responses. Involuntary responses include skin vasoconstriction and shivering. Unfortunately shivering is an extremely inefficient way of producing heat, significantly increasing utilisation of energy stores.

Voluntary responses include seeking shelter, putting on clothes, exercise and eating. These are much more effective, especially eating and exercise, which increases heat production by a factor of and eating. Once the core temperature goes below 32, shivering stops as thermoregulation fails. The body then gets stuck in a vicious cycle as dropping core temperature itself reduces body metabolism which in turn reduces the body temperature more.

The victim's body systems, particularly the heart and brain function, gradually slow down. The temperature at which any individual displays the various signs and symptoms of hypothermia varies as it depends on the factors mentioned above. It is also unusual to be able to accurately measure core body temperature in the pre-hospital environment. Therefore diagnosis must be made on clinical signs and symptoms alone. There are a number of different classifications of hypothermia.

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These have been developed in seperate areas of the world in response to their differing geography, rescue services and medical back-up. For the purposes of this article severe hypothermia is subdivided into moderate hypothermia, where the victim has stopped shivering but is not completely unconscious and severe hypothermia, where the victim is unconscious and signs of life are difficult to detect.

Ability to estimate which stage of hypothermia the victim has reached is important as this then allows treatment and possible evacuation to be planned. This is a very difficult situation in the wilderness. Technically only trained health care staff can actually pronounce death however in some circumstances it is recognised that attempts at resuscitation are futile.

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According to the Alaskan Guidelines these include obvious fatal injury, a core temperature of less than 10degrees C, an airway blocked by snow or ice, incompressible chest or eyeballs on gentle pressure - compare with live persons eyeball or finally not coming back to life once re-warmed. Below simple and effective treatments that can be given by non healthcare personnel in a wilderness environment are described. Mild hypothermia can be reversed relatively easily.

The key is to recognise it early and act swiftly. Shelter, warm clothes and warm food and drink will raise core temperature.

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Remember to insulate them from the ground. A thick plastic survival bag helps them retain any heat they are producing these have been shown to be more efficient than 'space blankets'. To add heat, body warmth can be used, for example putting the victim in a sleeping bag with someone else or using manoeuvres like a penguin huddle. Once re-warmed victims can generally then get themselves to a place of safety but should be watched carefully.

Moderate hypothermia: The patient will no longer be shivering and may have reduced level of consciousness.

This is a life-threatening situation. Their heart will already be at risk of arrhythmias. Good shelter needs to be found rapidly and the group should be prepared for a prolonged stop. The victim should be nursed lying down and insulated from the ground.

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If the conscious level is significantly reduced they should be placed in the recovery position to protect their airway. Any movement should be slow and gentle - a good policy is to treat them as if they have a spinal injury. Start re-warming as soon as possible:. Removing wet clothing and gently patting dry. Place them in a pre-warmed sleeping bag another person or hot water bottles can be used for this.

Add heat by using chemical heat packs or hot water bottles wrapped in cloth to prevent burns placed against armpits, upper abdomen, neck and groin. Heat sources should not be placed on limbs, the person should not be immersed in hot water and limbs should not be massaged as all these produce peripheral blood vessel dilatation which can cause paradoxical core cooling.

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