Rescue blankets are medical devices made of a polyethylene terephthalate sheet coated with a thin aluminum layer. Blankets are used for protection against hypothermia in prehospital emergency medicine and outdoor sports, but totally different qualities are typical for these multi-functional tools. On the one hand, rescue sheets prevent hypothermia by reducing thermo-convection and diminishing heat loss from evaporation and thermal radiation. On the other hand, the sheets promote cooling by acting as a radiant barrier, by providing shade and even by increasing heat conduction when the sheet is in direct contact with the skin. As foils are watertight and windproof, they can function as vapor barriers and even as stopgap bivouac sacks. We evaluated three experimental studies, one on heat loss by rescue blankets according to surface color, one on transparency with ultraviolet radiation, high-energy visible light and visible light, and one on infrared radiation from rescue blankets. When evaluating the effects of different bands of the electromagnetic spectrum on rescue sheets, we focused on ultraviolet radiation (200–380 nm), high-energy visible light in the violet/blue band (380–450 nm), visible light (380–760 nm) and infrared radiation (7500–13,500 nm). Rescue sheets transmit between 1% and 8% of visible light and about 1% of ultraviolet B radiation (280–315 nm), providing sufficient transparency and adequate protection from snow blindness. Reflection of visible light increases detectability in search and rescue missions performed in good visibility conditions, while reflection of infrared radiation increases detectability in poor visibility conditions and provides protection against hypothermia.

The utilization of rescue blankets in pre-hospital emergency medicine exceeds protection from hypothermia and enhanced visibility by far. In this narrative review, we focus on emphasizing the alternative applications of these fascinating multifunctional tools in the pre-hospital setting. A literature search in PubMed^® and Web of Science^TM yielded 100 results (last update was on 8 July 2022), a total number of 26 of which were included in this narrative review. Nine articles assessing alternative functions of rescue blanket were further evaluated and described in more detail. In addition, we performed various experimental and observational trials to test the functionality of rescue practice in mountain emergency medicine. Newly fabricated rescue blankets proved to possess impressive robustness. We evaluated rescue blankets in their applicability to not only protect from hypothermia, but also as practical tools to treat catastrophic hemorrhage and bleeding limbs, to perform open pneumothorax chest seals in sucking chest wounds, to prevent damage to unprotected eyes on the glacier and as alternative instruments for transportation in the inaccessible areas. Rescue blankets are important rescue equipment in alpine and wilderness emergencies with multifunctional applications, and must be part of every personal medical kit.

Lightning strikes pose a significant risk during outdoor activities. The connection between conventionally used rescue blankets in alpine emergencies and the risk of lightning injury is unclear. This experimental study investigated whether rescue blankets made of aluminum-coated polyethylene terephthalate increase the likelihood of lightning injuries. High-voltage experiments of up to 2.5 MV were conducted in a controlled laboratory setting, exposing manikins to realistic lightning discharges. In a balanced test environment, two conventionally used brands were investigated. Upward leaders frequently formed on the edges along the fold lines of the foils and were significantly longer in crumpled rescue blankets (p = 0.004). When a lightning strike occurred, the thin metallic layer evaporated at the contact point without igniting the blanket or damaging the underlying plastic film. The blankets diverted surface currents and prevented current flow to the manikins, indicating potentially protective effects. The findings of this experimental study suggest that upward leaders rise from the edge areas of rescue blankets, although there is no increased risk for a direct strike. Rescue blankets may even provide partial protection against exposure to electrical charges.