Fifth of a five-part series about low body temperature.

by James Hubbard, M.D., M.P.H.

These days it’s not unusual to hear of someone found in the cold, considered dead, who’s then revived. Someone knew how to treat severe hypothermia and didn’t give up. The saying goes, “They’re not dead until they’re warm and dead.”

Even so, not everyone is revivable. Most aren’t. Many’s heart just won’t restart, or they may have died from something else and then got cold. But unless you know the cause of death, or you’re not going to be able to warm them up within the next hour or two, keep trying to help the person.


The Goal: Keep Them Alive Until You Can Get Them Warm

One of the keys to treating an unconscious person with hypothermia is to get them someplace that has advanced warming techniques like warmed IV fluids, warmed breathing devices, and just plain heat. A severely hypothermic person has lost much of his or her body’s ability to generate heat.

Do what you can to get the person transferred, but keep yourself safe. If you’re out in the middle of a frozen nowhere, there is a finite amount of time and energy you can expend before you put yourself in danger of exhaustion and severe hypothermia.


What to Do Until Transfer

Here are some things you can do to help someone with severe hypothermia until you can get them to a treatment facility. But remember, everything must be done gently. A cold heart is easily irritated. A little jostling can change a normal heartbeat rhythm into a lethal one.

  1. Check for breathing. If none, make sure the tongue or something else isn’t blocking the airway.
  2. Check the pulse. Check well. The blood vessels close to the skin constrict when a person is cold, making a pulse harder to detect.
  3. Unless you know there has been no head or neck trauma, stabilize the neck.
  4. Get the person out of wet clothes, and cover him or her. It’d be great if you have a sleeping bag or such. All the better if you have some waterproof material to go outside the other covers. But even dry newspapers can be good makeshift insulation. Cover the person from head to toe, leaving only a space for breathing.
  5. If available, add hot packs to the neck and groin and under the arms.
  6. Get the person to shelter if help is not on the way.
  7. When in shelter, any external heat will do.
  8. If someone can start an IV, heat the IV fluids to at least body temperature and no warmer than, say, a hot bath.

That’s about all you can do in the field. Like most sayings, the one about not being dead until they’re warm and dead is not a concrete truth. Some people have been out in the cold and died of other causes. In cases when there is no medical expertise available, you might be the one to make the call.


Five-Part Hypothermia Series:

  1. Low body temperature: How cold is too cold?
  2. Risk factors for hypothermia (besides cold weather)
  3. Symptoms of hypothermia
  4. Hypothermia treatment, part one: How to treat a conscious person
  5. (This post) Hypothermia treatment, part two: How to treat an unconscious person