How do I recognise hypothermia, and what should I not do?
The signs, including the ones in babies that look like calm, the four things to do while waiting, and the four warming methods that instinct suggests and the guidance rules out.
- Difficulty
- beginner
- Time
- 7 min
- Read
- 4 min
- Safety
- warning
Short answer
Shivering, pale, cold and dry skin, slurred speech, slow breathing, tiredness or confusion. In a baby: cold to touch, floppy, unusually quiet and sleepy. Ring 999. Get them somewhere sheltered, remove wet clothing, wrap them in a blanket or sleeping bag, give a warm non-alcoholic drink and something sugary if they are fully awake, and keep them talking. No hot baths, no hot water bottles, no rubbing.
Hypothermia does not require Arctic conditions. It happens in British weather, indoors as well as out, to people who are wet, still, old, very young, or unable to keep a home warm. The things that make it dangerous to treat badly are counter-intuitive, which is why the list of what not to do matters as much as the list of what to do.
Safety
Step by step
- Recognise it in an adult.Shivering; skin that is pale, cold and dry; slurred speech; slow breathing; tiredness or confusion. Shivering stopping while the person is still cold is a sign of deterioration rather than recovery.
- Recognise it in a baby.Cold to touch, floppy, and unusually quiet and sleepy. A cold baby who is not crying and seems settled is the presentation that gets missed, and it needs urgent help.
- Ring 999.NHS advice is to go to A&E or ring 999 if you think someone has hypothermia, and not to drive there yourself. Say what has happened — cold water, a fall outdoors, an unheated home.
- Get them out of the cold.Indoors, or somewhere sheltered, as quickly as possible. Getting out of wind and rain matters more than the air temperature.
- Remove wet clothing and wrap them.Wet clothing removes heat far faster than cold air does. Replace it with a blanket, a sleeping bag or dry towels, covering the head as well.
- Give warm food and drink only if they are fully awake.A warm non-alcoholic drink and something sugary such as chocolate, if they are fully awake and able to swallow safely. Anyone drowsy or confused gets nothing by mouth.
- Keep them awake and talking.Talk to them until help arrives. It keeps them engaged and it lets you notice deterioration immediately.
- Do not warm them quickly or locally.No hot bath, no hot water bottle, no heat lamp, and no rubbing of arms, legs, hands or feet. Warming the surface and the extremities too fast is specifically warned against, and rubbing damages cold tissue.
Tips
- Wind and wet are what turn a cold day into a dangerous one. A soaked walker on a breezy hillside in ten degrees is at more risk than a dry one at zero.
- Cold water is the fastest route to hypothermia there is. Anyone recovered from cold water needs help even if they seem fine, because their core temperature keeps dropping after they are out.
- In an unheated home, one warm room is far better than a slightly less cold whole house. GuideHQ has guides on heating one room and on staying warm without turning the heating up.
Common mistakes
- Putting them in a hot bath — It is the classic instinct and it is specifically warned against. Rapid surface warming can be dangerous and it is not how hypothermia is treated.
- Rubbing their hands and feet — Cold tissue is fragile and rubbing damages it. It also moves cold blood from the extremities towards the core.
- Giving alcohol to warm them up — It feels warming because it opens the blood vessels in the skin, which is exactly what loses more heat from the core. NHS advice is explicitly not to give alcohol.
- Assuming a person who has stopped shivering is improving — Shivering stops as hypothermia deepens. In someone still cold, it is a sign of getting worse.
If it doesn't work
Someone has been pulled from cold water and says they are fine
Cause: Core temperature continues to fall after immersion — Fix: Treat them as hypothermic regardless. Dry clothing, shelter, warmth, and medical assessment — cold water incidents deteriorate after the rescue.
An older person is found confused in a cold house
Cause: Hypothermia developing slowly indoors, which is common and easily mistaken for confusion from another cause — Fix: Ring 999 and follow the steps. Indoor hypothermia in winter is a recognised pattern and it is worth checking on anyone vulnerable during a cold spell.
White, waxy, numb fingers or toes after cold exposure
Cause: Possible frostbite as well as hypothermia — Fix: Do not rub them and do not warm them with direct heat. Get medical help — hypothermia is treated first, and cold-injured tissue needs controlled rewarming.
Questions people ask
How cold does it have to be?
There is no threshold. Wet clothing, wind, immobility, alcohol, age and some medical conditions all mean hypothermia can develop in weather that feels merely unpleasant.
Can I use body heat to warm someone?
Sharing warmth inside a blanket or a sleeping bag is a reasonable field measure and is far gentler than a heat source. It is not a substitute for getting help.
Why does the guidance say not to drive them?
Because their condition can deteriorate on the way and an ambulance crew can manage that. It is the same reasoning as for a suspected heart attack or stroke.