Hypothermia and Other Cold Weather Injuries

by mobrian on January 22, 2009

Awareness of the Cold Part I

Hypothermia at its most simple is when you are losing heat faster than you can generate it.  It’s simple math that applies across the spectrum of ages.  Some groups are more susceptible than others, the very young or old, diabetics and those with peripheral vascular disease just to name a few.  For most it isn’t a serious threat, but it can be deadly.

As we are all aware it is not always possible to stay inside on these cold winter days.  For those who must brave the elements there are some simple precautions that can help us stay safe and as warm as possible.

What types of symptoms usually occur?

The symptoms are typically a slow progression.  The sufferer often is not aware that they may need medical attention.

  • Cold: hands, feet, face……
  • Fatigue / Sleepiness
  • Shivering (not always seen in older adults)
  • Confusion / Mental Status Change
  • The”-umbles,”  (stumbles, mumbles, grumbles and fumbles)
  • Shallow / Slow Respiration  (late sign)
  • Weak Pulses and Low Blood Pressure  (late sign)

In the very young these symptoms can occur in even mildly cold environments.  For example a child who sleeps in a very cool room without proper clothing on can develop hypothermia and mimic other medical emergencies.  This is also a potential problem for the elderly and those with peripheral vascular and neurological issues.  If the person doesn’t feel the loss of heat they won’t know to go to a warmer environment or take other actions.

Diagnosing Hypothermia

According to the National Institute of Health a core temperature of less than 96 degrees F qualifies as hypothermia.  This can be tested using a thermometer to assess their temperature or to test the temperature of the patients’ urine.  Other symptom presentation is also taken into account in the diagnosis.



  • Move the person out of the cold as soon as you are able.
  • Remove any wet clothing.
  • Wrap the person in warm blankets, covering the head too.
  • Apply heat packs to the armpits, groin and neck.
  • Provide warm, not hot, fluids.
  • If necessary use warmed IV fluids.
  • Re-warm at a gradual pace, not too rapidly.
  • As always monitor the patient.


  • Handle the patient roughly or rub the skin.
  • Allow the person to walk, unless absolutely necessary.
  • Give hot liquids.
  • Apply hot water bottles, electric blankets or heating pads directly to the skin.
  • Provide alcoholic beverages.
  • Force anything to eat or drink.
  • Warm extremities before warming the core.


The simplest prevention begins with proper nutrition and hydration.  Our skin is the biggest organ we have and needs to be well fed and properly hydrated to do its job.  If we are loaded up on fast food and caffeine it is hard for our bodies to overcome an external assault.  When we have good nutrition and hydration our bodies function at their best, to properly circulate the blood that perfuses and warms our skin.

Dressing for the weather is also very important.  If you are going to be exerting yourself plan to dress in loose fitting layers to allow for removal of clothing as the level of work increases.  Sweating, especially in cold weather, can be harmful.  Once you are wet it is much harder to control your body temperature.

Proper protective gear is of course essential.  Keeping your head covered is a must, according to Wintercampers.com the head is responsible for anywhere from 20-40% of our heat loss, due to its proportionally high blood flow, despite being only 10% of the total surface area of our body.  Mittens are better than gloves to allow the fingers to share warmth.  Blocking the wind is another consideration to avoid potentially rapid heat loss.

If skin is left exposed it is at risk for other related cold weather injuries.

Reminder; Treatment of injuries must be in accordance with department and EMS policy.

Article by Alan Ramsay a Career Firefighter, Paramedic and RN

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