What is the immediate treatment for hypothermia?

Immediate Treatment for Hypothermia

The immediate treatment for hypothermia should include removing the person from the cold environment, removing wet clothing, protecting them from further heat loss with blankets, and initiating active rewarming methods if resources are available. 1

Assessment and Classification

Hypothermia severity can be classified based on core temperature and clinical presentation:

Severity Level	Temperature	Clinical Signs	Rewarming Approach
Cold stress	35-37°C	Alert, possibly shivering	Passive rewarming
Mild	32-35°C	Altered mental status, shivering	Passive + active external warming
Moderate	28-32°C	Decreased responsiveness, ±shivering	All available passive and active methods
Severe/profound	<28°C	Unresponsive, appears lifeless	Emergency intervention with active core rewarming

Since first aid providers typically cannot measure core body temperature, assessment must be guided by signs and symptoms 1.

Step-by-Step Management Algorithm

1. Initial Actions (All Patients)

• Move the person to a warm environment if possible 1
• Remove wet/saturated clothing 1
• Insulate from the ground 1
• Cover head and neck 1
• Shield from wind using plastic or foil layer plus dry insulating layer 1

2. Based on Severity:

For Cold Stress (35-37°C) or Mild Hypothermia (32-35°C) with Alert Patient:

• Apply passive rewarming with dry blankets 1, 2
• Provide high-calorie foods or drinks if the person can safely consume them 1
• Monitor for signs of deterioration

For Mild to Moderate Hypothermia (28-35°C):

• Apply passive rewarming techniques
• Add active external rewarming:
  • Chemical heat blankets
  • Forced warm air systems
  • Heating pads 1, 2
• If wearing damp (not saturated) clothing like polyester fleece and cannot be moved to warm environment, use hypothermia wrap technique with chemical heat blankets, plastic/foil layers, and insulative blankets 1

For Severe/Profound Hypothermia (<28°C) or Decreased Responsiveness:

• Activate emergency response system immediately 1
• Continue all available passive and active rewarming methods 1, 2
• Handle patient gently to prevent arrhythmias 2
• In hospital settings, active core rewarming will be needed (warmed IV fluids, heated humidified oxygen, body cavity lavage) 2, 3

Safety Precautions

• When using any rewarming device, follow manufacturer's instructions 1
• Place insulation between heat source and skin to prevent burns 1
• Monitor frequently for burns and pressure injuries 1
• Body-to-body rewarming is not recommended over other active rewarming techniques 1

Special Considerations

• Hypothermia with decreased responsiveness (responding only to loud voice or pain) is a medical emergency 1

• Signs requiring immediate emergency response activation include:

  • Unresponsiveness
  • Inability to remain awake
  • Mumbling speech
  • Confusion
  • Inability to participate in removal of clothing
  • Pallor, cyanosis, or frozen skin 1

• Continue warming until core temperature reaches 36°C, and stop after reaching 37°C to avoid overheating 2

The treatment approach should be guided by the severity of hypothermia rather than clinical presentation alone, as there can sometimes be incongruence between symptoms and actual core temperature 4. Early recognition and implementation of appropriate warming strategies significantly reduce morbidity and mortality in hypothermia cases 2.