Preventing hypothermia: comparison of current devices used by the US Army in an in vitro warmed fluid model.

BACKGROUND: The purpose of this study was to develop an in vitro torso model constructed with fluid bags and to determine whether this model could be used to differentiate between the heat prevention performance of devices with active chemical or radiant forced-air heating systems compared with passive heat loss prevention devices.

METHODS: We tested three active (Hypothermia Prevention Management Kit [HPMK], Ready-Heat, and Bair Hugger) and five passive (wool, space blankets, Blizzard blankets, human remains pouch, and Hot Pocket) hypothermia prevention products. Active warming devices included products with chemically or electrically heated systems. Both groups were tested on a fluid model warmed to 37 degrees C versus a control with no warming device. Core temperatures were recorded every 5 minutes for 120 minutes in total.

RESULTS: Products that prevent heat loss with an actively heated element performed better than most passive prevention methods. The original HPMK achieved and maintained significantly higher temperatures than all other methods and the controls at 120 minutes (p < 0.05). None of the devices with an actively heated element achieved the sustained 44 degrees C that could damage human tissue if left in place for 6 hours. The best passive methods of heat loss prevention were the Hot Pocket and Blizzard blanket, which performed the same as two of the three active heating methods tested at 120 minutes.

CONCLUSIONS: Our in vitro fluid bag "torso" model seemed sensitive to detect heat loss in the evaluation of several active or passive warming devices. All active and most passive devices were better than wool blankets. Under conditions near room temperature, passive warming methods (Blizzard blanket or the Hot Pocket) were as effective as active warming devices other than the original HPMK. Further studies are necessary to determine how these data can translate to field conditions in preventing heat loss in combat casualties.