It was dark and snowing when Mark Wolfberg responded to an emergency call in the early morning hours of a cold, winter day.
He and other members of a police dive team headed to Bloomsburg, Pennsylvania, where a car had been found in the river.
When he arrived, he noticed ice forming on the surface of the water. Since the responders had a limited number of dry suits, Wolfberg strapped on a wet suit and dove into the river in search of the driver, who had been ejected from the vehicle.
He was extremely cold at first, but as he continued to swim around the bottom of the river, searching with a flashlight, it seemed as though he was starting to warm up. But that wasn’t the case at all.
“Hypothermia was setting in,” he said. “I wasn’t warming up, I was just becoming numb.”
He had been in the water for more than a half hour when he finally surfaced, got into a boat and came to shore.
“When I got out of the water, I just started shaking uncontrollably,” he remembered.
He was also experiencing confusion. The paramedics on site immediately took him into one of the ambulances, where they found his temperature to be dangerously low.
The heat in the back of the ambulance was turned up as more EMTs arrived to help him get out of the wet suit and wrap him in blankets. It took 30 minutes just to start feeling warm again, and he experienced a debilitating headache.
As an EMT, Wolfberg had treated hypothermia a number of times, but experiencing it himself was a surprise.
He was shocked at how rapidly it took hold, and calls it a “potentially silent killer” if you aren’t aware of or respond to the warning signs.
“It kind of sneaks up on you,” he said. “You don't realize it’s happening to you.”
Every year, hospitals in the central Pennsylvania region respond to varying levels of hypothermia and frostbite cases. When the temperature drops, the danger rises. Medical professionals say awareness and precautions are key to saving yourself, loved ones, and neighbors from possibly tragic outcomes.
Yechiel Reit, emergency room physician at UPMC Sunbury, defines hypothermia as a drop in the core, or internal, temperature of the body. If this temperature drops more than two to three degrees, a person begins to shiver. If it drops five to eight degrees, shivering stops and the person will begin to lose critical body heat.
“Shivering is a protective mechanism,” Reit explains. “The body tries to protect itself by generating heat through muscle action.”
But if there is a significant drop, the body will just give up, he said.
“As the body temperature gets lower and lower, many systems in the body begin to fail. Eventually, as it gets low enough, it causes the heart to stop beating and people die.”
The No. 1 cause of death from hypothermia is due to cardiac arrhythmia, Reit said.
Frostbite is another common cold-weather health danger. This is when the cold causes damage to limbs, especially fingertips, tips of toes, ears, and nose. Frostbite happens when these extremities “can’t maintain their heat, and fluids within the cells being to freeze,” Reit said.
Symptoms of both typically happen slowly, said Deb Erdman, a registered nurse and injury prevention and outreach coordinator with the trauma program at Geisinger Medical Center in Danville.
The “telltale signs” of the onset of hypothermia, she said, is shivering — the body’s attempt to reset its thermostat. The diagnosis will be clear when that shivering becomes uncontrollable and is accompanied by slurred speech, drowsiness, and lack of coordination.
When the body experiences cold, Erdman explains, your blood travels to your core to protect your organs. This leaves extremities vulnerable. When they start to feel stiff, numb and tingly, and begin to turn red, Erdman said these are the first signs of frostnip — the first level of frostbite. The extreme danger sets in when the numbing and tingling sensation stops, and limbs and extremities start turning white and looking waxy. As you lose feeling in them, frostbite sets in — “and that is dangerous”, she said.
Lynn Taggart, director of the UPMC Sunbury emergency department, said most
of the hypothermia and frostbite cases they see are among the elderlv DODulation and those who are inebriated.
At Geisinger, Erdman said the most common cases are due to falls and car crashes. The falls typically involve older people on their way to the mailbox, to get the paper, or walking a dog. Rural car crashes could mean people are alone in the cold for a long time before EMS can get there.
Erdman said those most susceptible to hypothermia and frostbite are infants and small children, and older adults, who “have decreased capacity to retain their body heat.”
According to Reit, “The cause of hypothermia is generally, in our society, people who are not making an effort to protect themselves.” This is typically when people are under the influence, or who have a mental illness. In rare cases, it might be a child who has gotten lost in the cold.
Being wet also causes hypothermia to set in more quickly. Whether your get caught in the rain or snow, or start to sweat, the propensity for trouble rises.
Treatment for hypothermia and frostbite varies according to the severity of the case.
In the case of hypothermia, Reit said, “The most important thing is getting the person out of the cold, in a warm environment, and getting any wet clothes off of them.”
Erdman said it’s important not to put the person under a hot shower, but rather to warm them up with lukewarm water. You should also not rub their skin or their extremities, since this could cause blistering. Keep them away from a stove or fire, as a hypothermic person will not feel the intensity of the heat and could burn themselves. They can drink warm fluids, but never alcohol.
“If a person is hypothermic to the point where their brain is not functioning correctly, and they are confused and not answering questions correctly,” Reit said, “they need medical care.”
Medical care for frostbite should be sought if extremities are changing color. In some cases, this could take several weeks to materialize.
“Damage from frostbite is very hard to know in realtime,” Reit said. From red to then white, and eventually dark blue and black, if it reaches the last stage, the damage becomes irreversible. In extreme cases, a finger or toe may need to be amputated.
Preventing these dangerous, cold-weather medical conditions often will come down common sense, and always being aware of yourself and others. Erdman said in cold weather, you should decrease the amount of time you spend outside, if possible. If you work outside, be sure to dress in loose layers. Avoid cotton, which keeps moisture close to your body, and instead wear inner layers of wool, silk, or polypropylene.
Be ever mindful that if you sweat, you need to remove wet clothes right away. Also, remember that hypothermia is not just a danger in freezing conditions; it can be experienced in even 40-degree weather if someone is not dressed properly, Erdman said.
“Watch your little ones,” she added, as those little red noses and cheeks could be the first signs of frostnip or hypothermia. And if you are an older adult, make sure someone knows when you’ll be going outside, and for how long.
After Wolfberg’s scare with hypothermia, the rest of the rescue team knew to limit their time in the water. They learned the importance of taking regular breaks to warm up, before heading out again.
Wolfberg said moderation in exposure, as well as constantly paying attention to environmental conditions, is key.
“You have to be cognizant of taking the appropriate safety measures,” he said, adding, “You have to be able to take care of yourself. You can’t think you’re going to power through it.”