Surviving The Cold

The problem:

The UK has been experiencing a cold snap, with regular overnight sub-zero temperatures, and on some days, the thermometers barely registering above zero in the daytime. Similar weather conditions prevailed at the beginning of this year.

 Most of us have been complaining about the cold, and travel difficulties, but have shelter and heating to which we can return. What about the homeless, or those in severe financial difficulty who cannot afford heating fuel bills despite Cold Weather Payments (and Winter Fuel Payments for the over-60s)? Or those who may not even have their utilities connected because of existing debts?

The danger is of hypothermia (the body temperature dropping below 35°C [95°F]), which can of course lead to death. People talk about ‘freezing to death’, but this is not literally true, as death occurs well before actual freezing of the body. In those who do not die, there is the danger of frostbite, and also an increased tendency to respiratory and other infections.

Concern has been voiced this month by organisations in Bath re the possibility of deaths among rough sleepers:

‘“Homelessness charities say deaths on the streets of Bath are a “very real” prospect this winter as temperatures plummet. Organisations are working together to extend the helping hand offered to the rising numbers of people forced to sleep rough in the city. Staff at Julian House have increased the opening hours of its night shelter in Manvers Street to 24 hours a day to provide respite from the cold – with the city centre likely to experience -8C conditions tonight. They are also working closely with the Genesis Trust which has a day centre in Corn Street, with staff at both groups putting in longer hours, and volunteers doing extra shifts”

“A Julian House spokesman said: “With even daytime temperatures hovering close to or below freezing, the threat of someone dying on the streets is perceived as very real.Most of us find it tough enough de-icing our cars in the morning, so imagine what it would be like to wake up in a car park with just a sleeping bag and a blanket.The fact that the daytime temperature is staying so cold is what makes things particularly dangerous right now. If you are on the streets with nowhere to go you just don’t get the opportunity to warm up. Most of our clients are not in the best of health anyway, which makes for a very hazardous situation.”

Deaths did indeed occur through hypothermia in the winter of 09/10 – for example, these reported in Norfolk and in Islington.

How can hypothermia be prevented?

(Adapted from the BBC information webpage, and with comments by myself)

“The Government offers extra support for some of the most vulnerable people in the form of winter fuel payments, to help keep their homes warm.”

See earlier in this piece regarding the cold weather and winter fuel payments. Also, those at risk of having, or who have had, their utilities cut off,  are strongly advised to discuss their situation with their local Citizens Advice Bureau, who are unfailingly helpful. Also helpful may be these links for those at risk of having their gas and/or their electricity cut off.

“Other ways to prevent hypothermia include:

• Stay indoors as much as possible and limit your exposure to the cold

Clearly a problem for rough sleepers. All local councils operate some severe weather provisions for rough sleepers. For example, in Wiltshire (p16 of link):

“Wiltshire Council will operate severe weather provisions for rough sleepers. The trigger for this is when the weather forecast predicts three consecutive nights with a minimum temperature of zero degrees Celsius or lower. In these cases the council will work very closely with voluntary agencies and housing providers so that rough sleepers can be brought in from the streets and be provided with emergency accommodation for the duration of the cold weather”

In the case of Chippenham, this has led to 5 overnight ‘beds’ being provided at Unity House Hostel.

(Homeless Link has issued a Good Practice note on the Severe Weather Emergency Protocols.)

• Eat regularly and include plenty of carbohydrates (eg bread, potatoes, pasta, rice) (the body needs a reliable and constant energy supply to generate heat)
• Keep as active as possible
• Avoid alcohol – it causes dilation of peripheral blood vessels, increasing heat loss
• Avoid caffeine – it’s a diuretic (makes you pass more urine) and increases the risk of dehydration, which aggravates heat loss
• Avoid nicotine – it constricts blood vessels and increases the risk of cold damage such as frostbite
• Wear multiple thin layers of clothing that help to trap air layers and hence traps heat, rather than one thick jumper
• If you go outside, always wear a hat (it can prevent as much as 20 per cent of heat loss), scarf and gloves”

What to look for – symptoms & signs of hypothermia:

“Watch out for the ‘umbles’: stumbles, mumbles, fumbles and grumbles. These are symptoms that show a gradual reduction in coordination of muscles and movement, and a falling level of consciousness.

Symptoms progress as the person’s temperature drops:

• Initially, involuntary shivering, loss of complex motor skills (but still able to walk and talk), shutdown of blood vessels in the hands and feet.
• As temperature falls below 35°C (95°F), violent shivering, impaired consciousness, loss of fine-motor coordination, especially in the hands (can’t handle or pick things up properly, drops things), slurred speech, illogical behaviour, loss of emotional cognition – an ‘I don’t care’ attitude.
• As core temperature falls below 34°C (92°F), the effects becomes life threatening, shivering become intermittent and then stops, the person curls into the foetal position, muscles become rigid, pupils dilate, pulse rate drops.
• By 30°C (86°F) the person looks dead. Although still alive, they’re in a state known as the ‘metabolic icebox’, breathing becomes shallow and erratic, consciousness is lost and the heart becomes vulnerable to deadly arrhythmias  (heart rhythm becoming irregular)

Shivering is one of several symptoms that can be used to assess hypothermia. If the person is able to stop themselves shivering, their hypothermia is only mild. If it can’t be stopped voluntarily, the person has moderate to severe hypothermia.

Another quick test is to assess higher brain functioning by asking the person to count backwards from 100 in multiples of nine. This sort of cerebral ability is soon lost as temperature falls.

A sign of severe hypothermia is loss of the pulse at the wrist, a result of the circulation shutting down”.

What’s the treatment?:

“Severe hypothermia needs urgent medical attention – call 999.

The basic principles are to stop heat loss and preserve the heat the person has, and provide body fuel to generate more heat. If a person is shivering, they can warm themselves at a rate of 2°C an hour.

Put on additional layers of clothing and replace wet clothes with dry. Get them moving to increase their activity and ensure their surroundings are as warm and still as possible.

Provide food, initially as hot liquids. Carbohydrates provide a rapid source of energy while fats can provide a prolonged source of fuel. Add warmth with a fire or heater, or by body-to-body contact.”

If there is access to a space blanket, this can be invaluable.

But whatever you remember about mountain rescue St Bernards with their flasks of brandy, do NOT give alcohol, as already mentioned  – that initial glowing feeling it gives is only temporary, before the alcohol makes the problem worse.

Other rough sleepers, and those who work with them, may well be the first people to realise there is a problem, so it was good to read of an initiative earlier this year by the Red Cross to educate homeless people, day centre staff and volunteers:

“The British Red Cross is teaching homeless people in Peterborough how to treat hypothermia and frostbite, in response to the sub-zero temperatures of the last few weeks. Red Cross first aid volunteer Jane Koe spent an afternoon at St Theresa’s Day Centre in Peterborough, giving advice to a group of homeless people, centre staff and volunteers. Denise Lewis, client services manager for St Theresa’s, attended the session. She said: “It was very informative. Everybody learned something they didn’t know before. There were a couple of rough sleepers in the group who were engaging really well and asking lots of questions – as the training was particularly relevant to them. Participants were also given reminder notes to keep in their pockets. It was such a success that we are aiming to run more sessions at the centre this week.”

So though wintry weather can be very pretty as well, remember the health realities behind the Christmas card imagery.