• Kazue Oshiro, Takashi Matsumoto, Takeshi Nawa, Takayuki Sakuta, and Tomikazu Murakami.
• Cardiovascular Department, Mountain Medicine, Research, & Survey Division, Sapporo Kojinkai Memorial Hospital, Miyanosawa2-1-16-1, Nishi-ku, Sapporo City 063-0052, Hokkaido, Japan; Division of Respiratory Medicine, Department of Internal Medicine Nihon University School of Medicine, Kandasurugadai 1-6, Chiyoda-ku, 101-8309 Tokyo, Japan; Department of Emergency Medicine, Sapporo Tokushukai Hospital, Oyachihigashi1-1-1, Atsubetsu-ku, Sapporo City 004-0041, Hokkaido, Japan; Association for Mountain Medical Rescue Japan, Odorinishi28-3-5, Chuou-ku, Sapporo City 064-0820, Hokkaido, Japan. Electronic address: kazooshiro@gmail.com.
• Am J Emerg Med. 2024 Nov 1; 85: 717971-79.

BackgroundAccidental hypothermia (AH) is a major cause of death in mountainous areas globally, and the second highest of mountaineering deaths in Japan, accounting for 37 % in Hokkaido. Managing AH is a significant challenge, particularly when adverse weather complicates the application of recommended rewarming and rapid transfer. To address this, the Hokkaido Police Organization (DOKEI) AH protocol was applied in Hokkaido's remote areas from 2011 to 2022, integrating high-temperature active external rewarming (HT-AER) with on-site sustained treatment.MethodsThis study retrospectively analyzed the rescue reports and hospital records of hypothermia patients treated postprotocol, excluding patients with cold exposure, undetectable vital signs at rescue, and inadequate documentation. Protocol adherence and outcomes-hypothermia stage, cardiocirculatory collapse, survival, and neurological status-were assessed.ResultsAmong the 60 protocol-treated patients (19-74 years, 85 % male), 14 had stage 2 hypothermia, and 3 had stage 3 hypothermia. HT-AER was applied in 96.7 % of the patients. A total of 98.3 % of patients improved before handover without cardiac arrest (CA) or extracorporeal life support (ECLS). Comparatively, ten preprotocol patients (18-60 years, 70 % male) had two CAs, one fatal and six with no improvement.ConclusionThe DOKEI AH protocol demonstrates feasibility in managing stages 1-3 hypothermia, enhancing survival and neurological recovery, and can offer a vital option in challenging AH rescue scenarios.Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.

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