BACKGROUND

Hypothermia, coagulopathy, and acidosis are the physiological derangements constituting the “triad of death” in trauma patients.1–4 Here, we use the term trauma-induced hypothermia (TIH) as it relates more specifically to combat trauma including hemorrhagic shock, cerebrospinal injury, and burns - all of which lead to a significantly increased risk of mortality and presents as a separate, more severe entity than non-traumatic or environmental hypothermia. TIH is a ubiquitous concern regardless of the environment as it can occur even in warm climates, as has been the experience in the Middle East.5

The Hypothermia CPG, initially published in 2006, was one of the first JTS CPGs. Prior to this, the rate of hypothermia (Temp <97 F) in patients arriving to the first role of care was as high as 15.42% in 2004. The rate initially dropped by over half to 7.26%. While it slowly increased again, it should be noted that missing temperature data in the DoD Trauma Registry (DoDTR) was as high as 42% when large volumes of casualties were being seen in 2003. The rate of missing data dropped significantly when the CPG was published yet remained in the 10-20% range. It is unclear if the true incidence was higher before 2006, but this potentially shows a Hawthorne effect and the effectiveness of tracking information to inform clinical practice. Figure 1 shows the trend in hypothermia by U.S. Military patients by year at any medical treatment facility (MTF). The purpose of this CPG is to provide guidance for the prevention and management of TIH in the combat casualty throughout the escalating roles of care.