Hypothermia

The harrowing details of the rescue operation that save 12 adolescent Thai soccer players and their coach from Thailand’s monsoon flooded Tham Luang cave were report shortly after the effort ended, but the specifics of their medical care before, during, and after the rescue have been hazy.
Now, a research letter publish online today in the New England Journal of Medicine details; how the medical team prepare each boy for the approximately 6-hour journey from their ledge to the cave mouth. Initially, officials expect that the boys would need to remain in the cave for several months until the monsoon season ended; but “with impending monsoon rains and concerns about falling oxygen levels in the cave; so plan to urgently extricate the patients was developed, write Maj.

Biggest concerns was hypothermia

Chanrit Lawthaweesawat, MD, of the Medical Association of Thailand and Bumrungrad International Hospital; hence both in Bangkok, and three colleagues on the medical team. The team, led by coauthor Maj. Gen. Wutichai Isara, MD; so include 50 to 60 physicians and more than 100 medical personnel who were on duty each day, plus a backup team standing by around the clock.

Among the biggest concerns was hypothermia, the authors explain, because the boys spend approximately 2 hours submerge in water; so that was near 20° Celsius as a certified cave diver transport them toward the exit. Throughout the rescue, two patients develop mild hypothermia ; so one on the first day and one on the second day of the rescue.

Initially, the greatest concern was with regard to the third day; because the last group of boys were younger and smaller than the others. However, “the transfer process was very fast” and none of the boys develop hypothermia; so because the group knew the protocols well by that point.
Because of the length of each one-way journey to the cave mouth; so much of it underwater and through narrow, flood passages, the team also worried about the boys panicking. Each boy therefore received alprazolam 0.5 mg orally and an intramuscular injection of atropine 20 μg/kg; follow by an intramuscular loading dose of ketamine 5 mg/kg.

Sedation for rescue operation

Sedation was atypical for such a rescue operation, but it was one of the those on-site; so decisions that was certainly reasonable to proceed with, Col. Will Smith, MD, of the US Army Reserve, who is medical director of Teton County Search and Rescue;  Grand Teton National Park, and other national parks teams.

Ketamine was an ideal choice of sedation because it can give intramuscularly and therefore underwater through a wet suit, while the person is unconscious if necessary. Ketamine was able to anesthetize the boys adequately to ensure that their muscles was relax during the trip. This enable the diver to carry them without the boys being aware of the dangerous, potentially frightening conditions.

Lawthaweesawat also emphasized the importance of establishing a public communications; so strategy early on for communicating updates to the press and the public at large. At the time of the rescue, the team withheld the fact that the boys were sedate with ketamine; so because they advise it be difficult to explain the reasoning to the public. Having strategies in place ahead of time would have been helpful.
Despite the unique, extreme challenges of the rescue, the team was ultimately successful; so all the boys and their coach are in good health today and have received mental health counseling. Everybody at the field did a great job for their specific expertise with minimal confusing overlaps. All doctors tried hard to use their ability, capability, and their specialization in various fields to overcome all obstacles under the limits of time and information.