1. 2015 The Paramedic Foundation, All Rights Reserved SEVERE HYPOTHERMIA IN A 50 MILE ULTRAMARATHON NICK NUDELL, MS, NRP EXECUTIVE DIRECTOR ULTRAMEDICAL TEAM 2. 2015 The Paramedic Foundation, All Rights Reserved 2015 LOST BOYS 50 MILE TRAIL RUN Point-to-point trail ultramarathon in San Diego County Potential entrants must have completed at a MINIMUM an official trail 50k race (within the race's qualifying time) 2015 Race is stopped at final aid station at hour 12 due to severe inclement weather & concerns for runner safety 15 hour limit Neil Feerick 8:23:46 & Tracy Dimino 9:44:14 56 finishers (78%) 3. 2015 The Paramedic Foundation, All Rights Reserved 4 miles (6.4km) of desert washes without roads or trails, 18 (29km) miles of jeep roads, and 28 miles (45km) of trails 4. 2015 The Paramedic Foundation, All Rights Reserved 9000 up (2740m) 6100 down (1860m) Range of 1200' (365m) to 6200 (1890m) 5. 2015 The Paramedic Foundation, All Rights Reserved NICE DESERT 6. 2015 The Paramedic Foundation, All Rights Reserved WIND? WHAT WIND? 7. 2015 The Paramedic Foundation, All Rights Reserved WHAT WEATHER? 8. 2015 The Paramedic Foundation, All Rights Reserved FINISH LINE SOAKING 9. 2015 The Paramedic Foundation, All Rights Reserved 2015 WEATHER 10. 2015 The Paramedic Foundation, All Rights Reserved WIND CHILL CHART 11. 2015 The Paramedic Foundation, All Rights Reserved WIND CHILL Australia Apparent Temperature The formula is: AT = Ta + 0.33e - 0.70ws - 4.00 Where: Ta = Dry bulb temperature (C) e = Water vapor pressure (hPa) ws = Wind speed (m/s) at an elevation of 10 meters The vapor pressure can be calculated from the temperature and relative humidity using the equation: e = (rh/100} * 6.105 * exp ((17.27 * Ta)/{237.7 + Ta)) Where: Ta = Dry bulb temperature (C) rh = Relative humidity [%] exp represents the exponential function 40F = 7C 40mph = 17m/s 100% humidity -7C = 19F http://planetcalc.com/2089/ 12. 2015 The Paramedic Foundation, All Rights Reserved STEVE: 54 YEAR OLD 2013 Boston 3:12, 4.5hr 50k, 8hr 50M (80km), 12hr 100K, 27hr 100M (161km) Sponsored triathelete & ultrarunner No pertinent medical history, great physical condition Wore 4 layers: running tank, two long sleeve tech tees, long sleeve synthetic material warmup pullover. Besides shorts also had calf sleeves, a thin skull cap, and cotton gloves. After 10 bonus miles Steve finds a friend off course they buddy up and become the last two runners on course 13. 2015 The Paramedic Foundation, All Rights Reserved GOING DOWNHILL 5pm: Buddy reports Steve was stumbling a lot and having difficulty moving forward 6pm: Buddy pulled Steve up last climb, mile 48 forward progress stopped 6:05pm: Buddy called 911 while running down to finish 6:15pm: Ultra Medical Team ED & safety sweep headed up 6:40pm: Steve was found in center of trail in the water runoff Awake, slow/minimal verbal response, not shivering, completely soaked, cold to touch, cant swallow gel 6:45pm: UMT began rewarming & requesting stokes basket 14. 2015 The Paramedic Foundation, All Rights Reserved SAN DIEGO BURRITO TrailDirection UMT Legs Steves Feet UMT Responder sits on mylar blanket with Steve Perpendicular in lap. UMT Responder wraps Own jacket around his head and is wrapped in several more mylar blankets face to face with Steve for an hour 15. 2015 The Paramedic Foundation, All Rights Reserved GOING DOWNHILL 30 minutes before fire department arrive, Steve starts to make slow rhythmic myoclonic movements 10 minutes before fire department arrives, Steve starts some on/off shivering of upper extremities in addition to myoclonus 7:45pm: Fire dept arrives with wheeled stokes basket 16. 2015 The Paramedic Foundation, All Rights Reserved 17. 2015 The Paramedic Foundation, All Rights Reserved 60+ MINUTE TRANSPORT 18. 2015 The Paramedic Foundation, All Rights Reserved CORE TEMP 82 F (28 C) ~2 hours after he was found After passive 2 hours of rewarming Core temp upon discovery possible ~78 F (25 C) Significant hypothermia, near cardiac arrest 19. 2015 The Paramedic Foundation, All Rights Reserved HYPOTHERMIA Hypothermia is classified as core temperatures rated as: Mild: 35C to 32C (90F to 95F) Moderate: 32C to 28C (82F to 90F) Severe: