Meet the Man Behind the HAT – Paramedic and rescuer Einar Fossli at the Norwegian Air Ambulance

28/12/2023

Einar Fossli is the man who launched the idea of the HAT (Hypothermia Active Treatment). He works as a paramedic and rescuer at the Norwegian Air Ambulance, and is the very brain behind our newly developed product. Learn how his idea turned into reality, based on Einar's own experiences.

-Hypothermia is a problem that can affect the morbidity and mortality of sick and injured patients. I believe that prehospital personnel, where possible, have a responsibility to deliver patients with normal body temperature. I was curious about whether we, in prehospital care, were doing everything we could to prevent inadvertent hypothermia. I had positive practical experiences from the operating room in conserving the neck and head with preheated blankets to reduce patient heat loss. At the same time, I noticed that there was little focus on the use of active rewarming in prehospital care. The options we had for headgear were very varied.

Being cold is uncomfortable in the same way that being nauseous and/or in pain is uncomfortable. Providing active rewarming to a cold patient is essential for relief and good care, while also aiming to reduce morbidity and mortality. Some patients occasionally need to be evacuated from challenging environments. Sometimes the patient needs to be evacuated hanging or lifted out by helicopter, or on various types of evacuation platforms on the ground, which expose the patient to hypothermia. I also saw it as advantageous to combine the HAT with a helmet, hearing protection, another cap, hood, sleeping bag, etc.

-The patient's head is often readily accessible to the personnel treating the patient. And some patients have much of their body covered but not their head. We also have large blood vessels in the neck that carry blood to and from the head, even as the patient gets colder. This provides an opportunity to quickly initiate central active rewarming. In many cases, the HAT can be used as soon as access to the patient is gained - before the patient is placed on a stretcher where it is easier to establish other active heating methods. Even when using the HAT, it is essential to provide heat to the upper body. It is the combination of all passive and active heat measures that gives results.

-Other active rewarming products that are electronically controlled with a thermostat (feedback loop) are structurally similar in principle, but these products are primarily designed for use on the upper body. HAT stands out by warming the neck/throat while simultaneously providing passive insulation to the head. Traditionally, some equipment for active rewarming that lacks medical approval has been used. Through various case reports and case series, several burn injuries have been described after improvised or non-approved equipment was used for active rewarming. By using medically approved products according to the instructions for use (IFU), which have undergone strict criteria for approval, the side effects of treatment are likely to be reduced.

Often, prehospital care must carefully prioritize the type of equipment to include in a medical kit, based on size and weight. The HAT is compact enough that personnel can carry it in a smaller bag along with other equipment or in a jacket pocket on the way to the patient.

-When I had the idea, I presented it to the Norwegian Air Ambulance Foundation (SNLA). They believed in it, and we started a collaboration. We hired Malsen Medical to assess whether this was a medical product. They were clear it was.

SNLA's target is for the product to help patients without seeking any financial profit. But we wanted to bring the HAT to the market. To realize the idea, we needed a forward-thinking company willing to develop and sell the product. We learned that Minitech AS had about 20 years of experience in selling products that provide active rewarming. This was interesting, and after a few initial meetings between SNLA, Malsen Medical, and Minitech, the collaboration was established. Since then, we have worked together purposefully to develop the HAT into the product it is today.

I really hope that the HAT, along with other active and passive hypothermia prevention measures, can help more patients receive the treatment they need to regain normal body temperature when they arrive at the hospital.