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Sunday, December 28, 2008

Paradoxical (and one not-so-paradoxical) Undressing

Several months ago, our SAR team was called out for an evidence search after part of a human skeleton was discovered on a cinder hill. Our objective, of course, was to find more bones as well as any additional clues or items that might lead to the identification of the deceased. Needless to say, the mission was very successful, solving a two-year-old missing person case.

What our team found was a full set of clothing--jacket, pants, shoes, underwear--along with the victim's identification and credit card right beside the neatly laid-out garments. So neat, in fact, they may as well have been put there only days before, had it not been for their weathered appearance.

Though some of my teammates and I theorized about the woman's death for weeks after the find, coming up with all sorts of scenarios, we eventually learned that the cause of death had been deemed exposure, as indicated in part by the fact that there was no visible trauma to her bones as well as the manner in which her clothing had been placed. Though I knew quite well what hypothermia was and thought I knew the various stages, I didn't recall ever hearing of a freezing person removing his or her clothing. That seemed counter-intuitive to me.

And then one of my (personal) blog readers posted a comment about "Paradoxical Undressing." It was the first time I'd heard the term, and, when I read the article, "Paradoxical Undressing: Irrational removal of clothing threatens hypothermia victim survival," it made more sense.

As I understand it, when a person becomes hypothermic, blood vessels in the outer extremities constrict, shunting blood to the core in the body's attempt to warm vital organs. The lack of blood in the extremities then causes those muscles to tire. As the muscles in the arms and legs tire, they relax, resulting in a dilation of the vessels and warm blood to rush back to the extremities, thus causing a false sense of overheating. And then the clothing starts coming off, because the victim is now "cold stupid," as the article puts it. Ultimately, the paradoxical undressing only serves to hasten the victim's death.

According to Wikipedia, as much as fifty percent of hypothermia deaths are associated with paradoxical undressing, a phenomenon that sometimes leads law enforcement to mistakenly assume that urban victims of hypothermia have been the victims of sexual assault, while rescuers trained in mountain survival have been taught to expect this effect.

Knowledgeable members of my own SAR team explained that, when paradoxical undressing occurs, the hypothermic person will often lay out their discarded clothing very neatly, as was the case with our find on the cinder hill, though I've yet to locate anything online about that fact. (Then again, it's past my bedtime.)

According to the before mentioned article, there's no known case of anyone who's reached the stage of paradoxical undressing having survived without outside intervention. Another article, this one from the Wilderness Medicine Newsletter, upholds that statement, though some who posted comments dispute that fact.

Both of the above articles cite a much-publicized event involving paradoxical undressing--that of the death of James Kim, after he and his family made a wrong turn and became snowbound while travelling home to San Francisco in late November, 2006. Mr. Kim tried to go for help, but his body was later found lying in the snow. He'd removed several articles of clothing, including his pants.

But on a different and happier note....

At least on one occasion, the subject of a Search & Rescue mission disrobed for the right reason. Apparently, this news story circulated around the web when it first ran in June, 2008, but I missed it. Read "Bra Helps in Rescue of Springs Hiker Stranded in Alps" if, like me, you may have been busy with SAR missions when this was all the buzz.

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