On wilderness medicine courses we often practice the hypothermia wrap in controlled conditions where a patient in dry clothing is placed into a sleeping bag, then wrapped in a vapor barrier. This plan does not fit this scenario, which is based on a real event. The scene is “unsafe,” not suitable for assessment and treatment. Wrapping the patient first in the tarp preserves the dryness of the sleeping bag and its insulation ability. Transport conditions are not ideal, but realistic.

Once a safe scene is found, in this case the back of the ambulance, assessment and treatment can proceed.

We also use the phrase “spine protection” in this scenario. This is new terminology reflecting rapidly evolving modern spine injury management concepts where backboards, straps and tape immobilization, and cervical collars are not necessary for all patients. In this case immobilization would have been impractical and regardless, the SAR responder providing hands-on protection of the cervical spine was within standards of care.