Hypothermia – Signs and Symptoms and Treatment

More about Winter Vehicle Preparedness Info.

To With more than half the country being inundated by massive snow and ice storms and much of the rest of the country having below freezing temperatures, people are at a very high risk for Hypothermia.  Knowing what Hypothermia is and how to treat it not only prepares you to help yourself but most importantly, to help others.  I’ve consulted several resources to try to put together a very comprehensive overview of Hypothermia.  Those resources include the Mayo Clinic, my EMT Training Manuals, the CDC Guidelines for Hypothermia and the State of Alaska Cold Injuries Guidelines (Alaska knows more about Hypothermia than anybody, their standards are what we use here for Search and Rescue).

Hopefully you’ll find this summary easy to understand and helpful.  If you come across someone experiencing Hypothermia you really need to know ahead of time how to deal with it!


Hypothermia is an emergency condition that occurs when the body is losing heat faster than it can generate or acquire it.  This results is a slow and steady decrease in core body temperature.  As the core temp drops below 95 degrees you begin to enter Hypothermia.  The body attempts to adjust to this heat loss by reducing perspiration and circulation to the skin – shutting down avenues by which the body usually gets rid of excess heat.  The body will try to compensate for heat loss by attempting to generate heat on its own by using muscular activity in the form of shivering by increasing the rate at which internal fuel (food) is burned.

Failure to get proper treatment for Hypothermia will result in death.

Signs and Symptoms of Hypothermia

  • Shivering – Uncontrollable and constant.  Shivering is the body’s automatic defense against losing heat, it is how the body attempts to warm itself
  • Clumsiness or loss of coordination
  • Slurred speech or mumbling
  • Confusion or difficulty thinking
  • Poor decision making – such as removing clothes because the person thinks they’re too hot
  • Drowsiness or very low energy
  • Apathy towards their condition
  • Progressive loss of consciousness
  • Weak Pulse
  • Shallow Breathing

Hypothermia comes on slowly and because it causes confusion, the victim is usually unaware of their condition.

Stages of Hypothermia
Core Body Temperature Symptoms
98 – 96 Shivering
95 – 91 Intense Shivering, difficulty Speaking
90 – 86 Shivering decreases and is replaced by strong muscular rigidity.  Muscle coordination is affected and erratic or jerky movements are produced.  Thinking is less clear, general comprehension is dulled, possible total amnesia.  Generally able to maintain the appearance of psychological contact with surroundings.
85 – 81 Becomes irrational, loses contact with environment, drifts into stuporous state.  Muscular rigidity continues.  pulse and respirations are slow and cardiac dysrhythmias may develop.
80 – 78 Loses consciousness and does not respond to spoken words.  Most reflexes cease to function.  Heartbeat slows further before cardiac arrest occurs.

General Principles of Hypothermia

  1. The body is actually protecting itself and its vital systems by going into Hypothermia.  Without taking these protective measures, the heart would fail and the person would die much sooner.
  2. Because the body has taken protective measures to protect itself, resuscitation efforts should be maintained beyond those for normothermic patients.
  3. In severe Hypothermia cardiac instability is an issue.  Physical stimuli such as jostling, exercise and chest compressions can cause ventricular fibrillation (heart attack) in a cold heart that is functioning effectively.
  4. In severe Hypothermia, compressions (CPR) should only be performed when functional cardiac activity is fully absent.  The pulse can be extremely difficult to feel and should be attempted for a prolonged amount of time (at least 45 seconds).
  5. Cardiac tissue in severe Hypothermia is resistant to defibrillation and anti-dysrhythmia medications.  These procedures are generally withheld until core temp has been raised to at least 86 degrees.

Treatment of Hypothermia

Basic Treatment for Hypothermia

  1. Prevent further heat loss
    1. Insulate from the ground
    2. Protect from the wind, eliminate evaporative heat loss by removing wet clothing
    3. Insulate the patient, including the head and neck
    4. Cover the patient with a vapor barrier (blue tarp, emergency blanket, large piece of plastic, etc)
    5. Move the patient to a warm environment
  2. Call 911, request an ambulance
  3. Do not give alcohol or permit patient to use tobacco

Treatment for Mild Hypothermia

  1. Follow procedures for Basic Treatment
  2. If there is no way to get to a medical facility, or it will be more than 30 minutes rewarm the patient with the following methods:
    1. Fuel their shivering with a very sugary drink (sugar content is more important than hot drinks)
    2. Do not allow the patient to drink liquids unless the patient is capable of swallowing
    3. Apply heat to areas of high surface heat transfer including the underarms, sides of the chest wall, the neck and groin.
    4. Place the patient in a sleeping bag and provide close skin-to-skin contact
    5. Consider a warm shower or bath for the patient
    6. Mild exercise such as walking or stepping up and down on an object will produce heat and may be helpful

Treatment for Severe Hypothermia (with signs of life)

  1. Treat patient very gently, do not rub or manipulate extremities.
  2. If clothes are wet, cut them off
  3. Treat for Basic and Mild Hypothermia except:
    1. Do not allow the patient to sit or stand until rewarmed (do not put in a bath)
    2. Do not give the patient oral fluids or foods
    3. Do not attempt to increase heat production through exercise
    4. Take to a hospital as soon as possible

Treatment for Severe Hypothermia (with NO signs of life)

  1. Treat as outlined in Severe Hypothermia WITH signs of Life
  2. Check for signs of breathing (coughing, chest movement, etc) for 60 seconds.  If patient is not breathing and does not have signs of circulation give 3 minutes of ventilation.
  3. Check for signs of breathing and circulation for 60 seconds.  If there are none, goto step 2
  4. Use mouth to mask breathing
  5. Transfer to a medical facility as soon as possible

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