Abstract: - Introduction: Accidental hypothermia in pre-hospital care (PHC) worsens the prognosis of victims of trauma and environmental exposure, forming part of the "Lethal Diamond" of trauma (hypothermia, acidosis, coagulopathy, and hypocalcemia). Despite its severity, simple preventive measures—such as thermal protection of the head—are frequently neglected in clinical practice. Objective: To review the pathophysiological underpinnings, clinical impact, and prevention strategies for accidental hypothermia in PHC, with an emphasis on the critical role of head protection. Methods: This is a narrative literature review involving searches across the PubMed, Scopus, Web of Science, and Google Scholar databases, as well as an analysis of international guidelines (PHTLS, ERC, WMS), prioritizing publications dated between 2010 and 2025. Results and Discussion: Heat loss in PHC occurs rapidly through conduction, convection, radiation, and evaporation. The head—due to its rich vascularization and lack of significant cold-induced vasoconstriction—acts as a critical zone for heat dissipation; it can account for up to 50% of radiant heat loss when the rest of the body is insulated. The early use of ground insulation, vapor barriers, and head coverings interrupts heat loss, thereby preventing hemodynamic and hemostatic deterioration. Conclusion: Preventing hypothermia in PHC is more effective and feasible than attempting its delayed reversal. Thermal protection of the head is a low-cost, high-impact clinical intervention that should be systematically incorporated into initial care protocols to improve patient survival.
Santos* et al. (Wed,) studied this question.
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