If you or someone nearby has hypothermia, the most important first step is getting out of the cold and removing any wet clothing immediately. Hypothermia sets in when core body temperature drops below 95°F (35°C), and every minute spent cold makes it harder for the body to recover. What you do in the first few minutes, and what you avoid doing, can determine whether the situation stays manageable or becomes life-threatening.
How to Recognize Hypothermia
Hypothermia often sneaks up on people. The confused thinking it causes actually prevents people from realizing something is wrong, which can lead to poor decisions and risk-taking behavior. If you’re with someone in cold conditions, watch for these signs: shivering (the body’s automatic attempt to generate heat), slurred or mumbled speech, slow and shallow breathing, a weak pulse, and noticeable clumsiness or lack of coordination. In infants, look for bright red skin that feels cold to the touch and unusually low energy.
Shivering is actually a relatively good sign. It means the body still has enough energy to try warming itself. When shivering stops but the person is still cold, that typically signals a more dangerous stage where the body’s defenses are failing.
Immediate Steps to Take
Move the person out of the cold as gently as possible. If you can’t get indoors, shield them from the wind, especially around the head and neck, where heat escapes fastest. Lay a blanket, tarp, or even extra clothing underneath them to insulate against the cold ground, which pulls heat away from the body surprisingly fast.
Remove wet clothing and replace it with warm, dry layers or blankets. Then focus warming efforts on the center of the body: the neck, chest, and groin. These areas have major blood vessels close to the surface, so warming them heats the blood flowing to vital organs. You can use warm compresses, a hot water bottle, a chemical heat pack, or an electric blanket if one is available. If you’re using a hot water bottle or heat pack, wrap it in a towel first to avoid burning the skin.
Offer warm, sweet drinks if the person is alert enough to swallow safely. The warmth helps from the inside, and the sugar provides quick energy the body can use to generate heat. Avoid alcohol and caffeinated beverages like coffee. Alcohol dilates blood vessels near the skin, which actually accelerates heat loss. Caffeine can constrict blood vessels and affect circulation in ways that work against rewarming.
If the person shows no signs of life (no breathing, coughing, or movement), begin CPR immediately and call emergency services.
Why Gentle Handling Matters
One of the most important and least intuitive rules of hypothermia care is to handle the person gently. A cold heart is electrically unstable, and rough movements can trigger a dangerous irregular heartbeat. Keep the person as still and horizontal as possible. Don’t have them walk around to “warm up.” Don’t vigorously rub their arms and legs.
This connects to a phenomenon called afterdrop. When someone with moderate or severe hypothermia is moved too aggressively, or when heat is applied to the arms and legs instead of the core, cold blood pooled in the extremities rushes back to the heart. This actually drops the core temperature further and increases the risk of cardiac arrest. It’s the reason you warm the center of the body first and keep the person lying flat.
What Not to Do
Several well-meaning instincts can make hypothermia worse:
- Don’t rub or massage the skin. This can damage tissue that’s already fragile from cold exposure and pushes cold blood toward the heart.
- Don’t place the person next to a heater or in a hot bath. Rapid external warming draws blood to the skin and away from internal organs, which can cause a dangerous drop in blood pressure.
- Don’t give alcohol. Despite the warming sensation, it increases heat loss through the skin.
- Don’t warm the arms and legs first. Focus on the chest, neck, and groin to avoid afterdrop.
The core principle is: rewarm slowly and from the center outward.
Mild vs. Moderate vs. Severe Hypothermia
How much intervention someone needs depends on how far their temperature has dropped. Mild hypothermia (90°F to 95°F) can often be managed with passive rewarming: getting out of the cold, dry clothing, blankets, and warm drinks. The body still has enough capacity to rewarm itself if you stop the heat loss.
Moderate hypothermia (86°F to 90°F) requires active external warming. This means applying heat sources to the body, like warm compresses, heated blankets, or forced warm air. At this stage, the person may have stopped shivering and could be confused or drowsy. They need emergency medical attention even if they seem stable.
Severe hypothermia (below 86°F) is a medical emergency that requires hospital treatment. At this temperature, the heart is at serious risk of stopping, and standard rewarming techniques are often not enough. Hospitals can use methods like warmed IV fluids, heated humidified oxygen, or in the most critical cases, a machine that warms the blood outside the body and pumps it back in. Severe hypothermia below 82°F is frequently fatal without these advanced interventions.
When the Heart Stops
If a severely hypothermic person goes into cardiac arrest, CPR should be started immediately and continued without interruption. Cold actually provides some protection to the brain and organs by slowing their need for oxygen, which means people have survived prolonged cardiac arrest from hypothermia that would be unsurvivable under normal conditions. There’s a saying in emergency medicine: “Nobody is dead until they’re warm and dead.”
This is why continuous CPR matters, even if it takes a long time for help to arrive. Mechanical CPR devices are recommended for prolonged rescues when available. If continuous chest compressions aren’t physically possible, alternate at least 5 minutes of CPR with no more than 5 minutes of rest.
Who Is Most at Risk
Hypothermia doesn’t only happen to hikers and skiers. Older adults with inadequate heating, food, or clothing are among the most common victims, often in their own homes. Aging reduces the body’s ability to regulate temperature and detect cold. Babies sleeping in cold bedrooms are also vulnerable because their small bodies lose heat quickly and they can’t shiver effectively or tell you they’re cold.
Other factors that increase risk include anything that limits circulation: smoking, tight clothing, alcohol use, and fatigue. People who are wet, even from sweat, lose heat far faster than those who are dry. Wind dramatically accelerates cooling as well, which is why blocking wind is one of the first priorities if you can’t get indoors.
After the Emergency
Even after someone with hypothermia begins to warm up and seems to feel better, their body has been under significant stress. Core temperature can continue to fluctuate, and the heart may remain vulnerable to irregular rhythms during the rewarming process. Anyone who has experienced more than mild hypothermia should be evaluated at a hospital, where their temperature and heart rhythm can be monitored as their body returns to normal. Keep them warm, still, and horizontal during transport.