Overcoming The Cold: Winter in North Dakota

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Disclaimer: this isn’t really medicine related, it’s moreso about staying warm.

It’s cold, ya’ll (this is without windchill)

I’ve been working in EMS for the past 8 years and almost all of my time has been in North Dakota and Montana. I’m used to the cold, but recently I had a new experience – while transferring an intubated patient from a ground ambulance to our airplane, the patient’s IV lines froze. It’s that cold.

Despite the -60º weather (with 70 mph winds), I’ve been staying relatively warm while outside, even warm enough to conduct flight operations outside the aircraft and still be fine. Now, if you’re reading and you don’t working in North Dakota or Alaska, you may already be thinking I’m crazy (and I am!)

It’s a cold one out there!

Dress for Success

The most important concept to understand is layering, which isn’t very hard. In this cold of weather, I routinely wear 4-5 layers: Base layer, mid layer, nomex flight suit, outer layer, and outer layer.

Note: Nomex flight suits don’t really help you. Ask someone and they’ll tell you nomex is good for 2 things: keeping you warm in the summer and cold in the winter. It’s true.

I am a huge fan of Smartwool (http://www.smartwool.com). Their wool is amazing during the winter. For my outer layers I prefer Patagonia (http://www.patagonia.com). My normal winter dress code looks like this:

  1. Wool base layer (https://www.smartwool.com/merino-250-base-layers.html)
  2. Silk mid layer (https://www.rei.com/c/mens-base-layer-bottoms & https://www.rei.com/c/mens-base-layer-tops)
  3. Nomex flight suit
  4. Outer layer (https://www.patagonia.com/product/mens-tres-3-in-1-parka/28387.html?dwvar_28387_color=BLK&cgid=mens-jackets-vests#start=1)
  5. Outer layer (https://www.patagonia.com/product/mens-tres-3-in-1-parka/28387.html?dwvar_28387_color=BLK&cgid=mens-jackets-vests#start=1)

Everything is long sleeve. The Patagonia 3-1 parka is nice as I can consistently remove the outer wind-blocking shell while in the aircraft to keep from getting too warm.

Many flight programs require natural fibers such as wool or silk, to remain fire retardant. While whether you’d survive a cabin fire is highly debated, I’d recommend checking with your program first.

This approach may not work for everyone, though. When we’re at base not in a flight, we’re not required to be in our flight suits, so I’m often in sweat pants and a t-shirt or hoodie. If you are a hospital based program, this may not be possible, as you’d be sweating as soon as you walked in for your shift.


Does this even need a caption?

As for protecting my head, hands, and feet, I’ve found some good options.

Head: During my fire department days, our department issued us fleece lined wool watch caps, and they’re amazing. So amazing, I bought myself 2. I purchased the Blauer lined watch cap (found here https://www.blauer.com/lined-watch-cap-125xcr.html) and haven’t looked back. Combine it with a wind proof hood of a jacket and you’re toasty.

Hands: I stick with a 2 layer method. The base layer is a fleece glove by The North Face (https://www.rei.com/product/135930/the-north-face-etip-gloves-mens), and the outer layer is Arc’teryx Alpha gloves (https://www.rei.com/product/116899/arcteryx-alpha-sl-gloves). This keeps my hands warm without having to wear giant mittens yet gives me functionality. With the dual layers, I can also shed one as necessary.

Feet: When it comes to the feet, I start by layering just as I do with torso and legs. My wool leggings come down to the ankle, then I put on my wool socks, that extend to my knees. Then, my silk leggings are put on over those, and then my boots. I just wear normal 5.11 boots, I don’t have specialized winter boots.This is just how I stay warm, and hopefully it helps you when the weather hits. My buddy Joel Porter (@FOAMedic1) is going through Snowmageddon2019, but don’t tell him I’m posting this!

If you’re looking for more information about dressing properly during flight operations, check out the podcast Skids Up, produced by Heavy Lies The Helmet (https://heavyliesthehelmet.com) that’s produced by Chris Sharpe, who discusses proper dress, as well as pertinent safety tips and survival skills. Episode 2, Dress for Egress, can be found here (https://heavyliesthehelmet.com/2018/07/27/chris002/) and I would highly recommend it!

Interested in more cold medicine? Check out Küpper, T. E. A. H., Schraut, B., Rieke, B., Hemmerling, A., Schöffl, V., & Steffgen, J. (2006). Drugs and Drug Administration in Extreme Environments. Journal of Travel Medicine, 13(1), 35–47. doi:10.1111/j.1708-8305.2006.00007.x 

In case you’re wondering about what I did with our intubated patient: We use the Lifeblanket, a 2 layer sleeping bag that provides protection for the patient, so the patient wasn’t exposed, only the pump and infusion lines. In this specific case once in the plane I accessed an IV, drew back until blood filled the IV lock, flushed it with a new saline flush, then administered 200 milligrams of ketamine and 5 milligrams of midazolam. After that, all the IV lines and mixed infusions were replaced with new.