Treating Hypothermia

Treating Hypothermia

How to treat Hypothermia on the hill

Image courtesy of Nigel Laughton

Treating Hypothermia 

Treating Hypothermia

Early recognition can lead to quick treatment and continuation of the day without much issue, but as symptoms progress the condition can become a serious medical emergency and meaning that it cannot be safely treated without medical intervention. 


Treating on the Hill

Having recognised some symptoms you should be able recognise the stage and seriousness of the condition, and one would hope that it’s only mild conditions when first noticed. Try to remove the causes.


At First Sign of Two or More Mild Symptoms

  • stop for a rest and take refuge from the elements, in a storm shelter if you have one (passive re-warning). This step will prevent further heat loss from convection, as well as being excellent for group morale and allowing everyone to eat some food without being battered by the elements.  You have one casualty, you don’t need more. 

  • Keep casualty off the ground - put them on a sit mat, rucksack or sleeping mat if you have one. Sitting them off the ground will prevent heat being conducted away from the body

  • If the casualty is wearing wet clothing, particularly next their skin, replace it with any dry clothing from others within the group if can do this inside a storm shelter, and quickly. Having something dry next to the skin will rapidly decrease the heat loss by conduction (remember, water conducts heat away from the body 25 to 30 times faster than air.)  It’s much better to whip off and replace a wet T shirt and expose to momentary additional cold than keep on a wet base layer. (Read story.)

  • Reduce exposed skin as much as possible, ensuring that the casualty wears a hat, neck gaiter or even a balaclava, thus preventing heat loss by radiation

  • Extra mid layers will insulate against the cold.  If you have an emergency jacket, now’s the time for the casualty to put it on.

  • Make sure that they consume some high calorie food.  Taking in a hot drink (active re-warming) can have immediate positive effects, and some people advocate carrying a small flask of hot water/juice for that purpose (do not give caffeine or alcohol).  Sachets of ‘drink mix’ are available that contain a high calorie count for their weight.  These can normally be mixed with cold water, but adding cold fluid to the casualty is not to be recommended.  If you have a high calorie drink mix, add it to hot water.

  • If you don’t have a flask of hot water, can you heat some? A small solid fuel stove & mess tin, can heat a mug of water in less than 5 minutes. If you're walking with a group, someone should have a flask or means to heat water. 

Recheck Symptoms 

After a few minutes you should be able to tell whether the shelter and food stop is having a warming effect the casualty.  If the casualty stops shivering and has a smile on their face, that’s a good sign.  In that situation you'd be advised to start walking again as heat is produced by the muscles when at exercise.

If the casualty stops shivering and is not smiling, that could mean that the condition has progressed to the next stage.  Check for some of the non-physical symptoms, such as mental confusion, amnesia, lethargy, slurred speech. Ask a few questions and see whether you get rational answers back from the casualty.

A constant assessment of symptoms is required, as is the recording of symptoms. 


Assuming little positive effect, an accumulation of mild category symptoms, or appearance of more severe symptoms, the next decisions include:

  • Is the condition treatable here?

  • If we stop here, will others be exposed to danger and the cold?

  • Should we carry on with the intended route? Return the same way, or down via an escape route (even if that route will take you away from your intended finishing point)



The answers to these questions depend various considerations, including:

  • whether it is safe (see below) to move the casualty, depending on the progression of symptoms

  • whether the casualty has enough muscle function to make it to safety without further risk, assuming it is safe to move the casualty. The distance to safety could be the major factor here. If the time it take to get to safety will take you into darkness, are there sufficient head torches available for everyone to make it off safely?

  • morale of the whole party 

  • the weather - exposure to wind & rain could make the situation worse

  • what kit do we have to attempt a further re-warm

  • remoteness from civilization - if you are a considerable distance from help, calling for help now could be the more sensible option

  • whether you can call for help quickly - do you have a mobile signal, or other means to call for help immediately


Moving the Casualty

A casualty with progressing moderate, or severe symptoms MUST NOT BE MOVED, as there is the potential for heart arrhythmia that could lead to cardiac arrest.  If you can confirm that the heart rate is fast, that is a sure sign that you need to stay where you are.  You may not be able to find a pulse on wrist or neck. A typical adult will have a resting heart rate between 60 and 80 beats per minute.  Anything over 100 after a few minutes rest would be considered high, although the casualty may have a higher than normal heart rate to start with for a number of medical reasons, or due to being unfit.


Potential Courses of Action

Mild Symptoms
If the casualty has up to two or three of the mild symptoms, the most appropriate next course of action would be to remove the casualty to a lower and less hostile environment.  They will need lots of encouragement, stops for rest and intake of more calories.

Moderate Symptoms

If more than a couple of the moderate symptoms appear, you need to stay put, stay in the shelter, lie them down and keep them in a horizontal position, get them into more warm dry clothes, into a survival bag and call for help.  Assuming that others in the group are not showing symptoms, and if you have other competent people in the group, it could be advisable to send other members of the group off the hill and into a less hostile environment.  Splitting the group is not to be done lightly, but better to reduce the danger to others if safe to do so.  Ideally two people need to stay with the casualty, and the message passed to the emergency services needs to be clear about intentions, and direction of travel for those leaving the scene.  If you have body or hand warmers, they can be used with care on the casualty in an attempt to re-warm as long as they are only of a mild to moderate heat.  Do not place the warmers directly next to the skin as that could cause blood to move to the skin, thus cooling the core further. Instead, place the warmers under armpits, on side of heck and on the chest, but with a layer or two of clothing between the warmers and skin.  Monitor the casualty’s symptoms, pulse if possible and rate of breathing and be prepared to start CPR is the condition deteriorates.


Severe Symptoms

Treat as for mild & moderate, but do not attempt to move the casualty. Call for help immediately.


  • Never put yourself at risk by exposing yourself to casualty’s low temperature.  In years gone by, skin to skin contact was recommended as a means of re-warming, but the consequence could be that your body temperature starts to drop as a result.  Be careful!
  • Never give the casualty any alcohol, as this causes vasodilatation leading to warm blood moving from the core to limbs, thus cooling the body further
  • Never rub the casualty’s skin in an attempt to re-warm.  In a similar way to giving alcohol, warm blood will be diverted away from the core to the skin, and rather than making the casualty warm, it could kill them
  • Never put warm or hot water onto the casualty in an attempt to speed-up re-warning


No Sign of Live

If the casualty is showing no sign of life, do not give up. The body's self preservation mechanisms can give the impression that the casualty is deceased, but there is no such thing as a cold and dead victim of hypothermia. Only warm casualties would be declared deceased.


Any serious re-warming attempt has to be conducted in hospital under medical supervision as there remains the potential for heart failure.




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