Hypothermia – Managing it in the Wilderness

Hypothermia is low body temperature. Just how low the body temperature gets will determine what signs and symptoms there are, as well as the treatment. Let’s imagine for a moment….

As a first aider with wilderness experience, you’re in much demand. Hearing about two hunters stranded on an ice floe, you’re bundled into a helicopter and flown out to help them. The pilot lands you safely on the ice, and you’re out of there, looking for the injured people. A sudden ‘crack’ like a gunshot and you whip your head round in time to see the helicopter and pilot starting to sink. If you can’t haul him out of the icy sea quickly, hypothermia will quickly progress.

3 Stages of Hypothermia

Hypothermia is progressive, the low body temperature, gettting worse if not quickly managed. Along with progressive physical changes will come a mental deterioration – don’t let your casualty override your better judgement!

Mild Hypothermia

• Shivering
• Complaining of Cold
• Numbness

Moderate Hypothermia

Above plus:

• Lack of coordination
• Possible lack of or changes to speech
• Confused
• Unusual behaviour
• Impaired judgement

Severe Hypothermia

• Shivering stops
• Complaining stops
• Breathing slows or stops
• Stiffness of body
• Potentially unconscious

Recognising Hypothermia

There’s a saying in wilderness first aid that a person with significant hypothermia has ‘the umbles’ – they stumble, they mumble and they fumble. Low body temperature is not always a good sign outside in the wilderness. The ‘body temperature’ you can take is often a reflection of the environment, not the person.

Treating Hypothermia

So you know what you got, now what do we do about it? Always ‘scene survey’ and always ‘ABCs‘ – in an unconscious person you suspect has hypothermia, you may need to extend the breathing check to (up to) 45 seconds!

Mild & Moderate

Much the same as in an urban setting:

• Get the person to shelter
• Remove wet clothing if applicable
• Get them dried off
• Replace any removed clothing with something dry, especially cover the head/neck area
• Eventually, warm fluids to rehydrate and high-energy foods

Treating Severe Hypothermia

• Do not put yourself or group members at risk of hypothermia as well!
• Insulate the body (see below)
• Handle them gently – no ‘jarring’ movements
• Remove to a dry, sheltered area
• Change clothing as appropriate
• Apply warm objects to high blood-flow areas (armpits, groins, back of neck)
• Treat for shock

Insulation for Hypothermia

• Remove wet clothing & redress.
• Wool toque to head
• Gloves & socks on them (if you lack gloves, use extra socks on the hands)
• Wrap them in a warm layer (eg: blanket)
• Then a waterproof layer (your bivvy bag or similar)
• Repeat alternate layers as needed
• Consider adding your ‘warm objects’ into the bundle
• Fold over ends/sides as needed. Consider a rope-tie or rope stretcher if you know how (it’s beyond the scope of this article).

Final thoughts

• A sheltered body will regain 1 degree C per hour
• Monitor for at least 24 hrs for afterdrop
• As they are re-warming, give water and high energy food. All that shivering burns a lot of energy!

Tony has been teaching First Aid for the Red Cross for about 20 years, is an approved Canadian Red Cross Training Partner and has a blog here.