We all enjoy spending time outside. Many appreciate winter activities like skiing, snowboarding, and even taking a nature walk in the snow. We may need to work outdoors, such as shoveling, snow blowing, or running errands, and getting sunlight exposure and fresh air benefits our health. However, prolonged exposure to cold or wet conditions, especially for those with health issues or inadequate protection, increases the risk of hypothermia — dangerously low body temperatures with severe, even life-threatening consequences.
Watch out for hypothermia
Cold weather doesn’t mean no fun and games outside. It does mean, however, that one needs to pay attention to clothing, protective gear, time spent in severe weather, and weather conditions (e.g., rain, snow, winds). You want to ensure you know how to protect yourself.
What is hypothermia?
To stave off hypothermia, you should understand what it means and what is happening in the body. Hypothermia, or cold-related illness, refers to a dangerously low body temperature. It occurs when the body’s energy stores are depleted due to prolonged exposure to cold. In other words, your body experiences heat loss more quickly than it can generate in cold temperatures.
According to the National Institute of Health’s National Library of Medicine, “A body temperature below 95°F (35°C) is a medical emergency and can lead to death if not treated promptly.”
Signs and symptoms of hypothermia
Recognizing the signs of cold injury early, getting prompt care, or taking action to improve the situation immediately can make the difference between life and death. The following are symptoms of hypothermia:
- Mental confusion (disorientation, forgetfulness)
- Cold skin
- Decreased breathing or heart rates
- Severe shivering
- Severe shivering that suddenly stops despite remaining in the triggering environment
- Slurred speech
- Dropping things/clumsiness
For babies who cannot verbalize cold, their skin may be cold and bright red, and their energy level may be dramatically decreased.
Risk factors for hypothermia
Certain individuals are at higher risk for developing hypothermia than others. However, anyone, when conditions are right, can be affected. For the following groups, the risks are increased:
- Those who use illegal drugs.
- Those who consume alcohol.
- Those outdoors for long periods (e.g., hunters, hikers, homeless).
- Older adults, especially without heat or proper attire.
- Babies who sleep without adequate heating/clothing or are bathed in cool/cold water.
- Those with underlying health problems, including heart disease or diabetes.
- Those with limited memory or physical disabilities that prevent them from finding suitable environmental conditions.
- Those who lose power for long periods and do not properly prepare.
- Individuals with bad circulation (e.g., the elderly, smokers, those affected by medications, diabetes, or Raynaud’s syndrome).
- Younger kids and infants, as their bodies are still developing, and they often lack the verbal abilities to express that they are cold or in trouble.
If you or someone you are with shows signs of hypothermia, immediate medical care is essential to prevent the onset of life-threatening complications and ensure that other detrimental effects do not occur.
Treatment includes getting out of the elements and into a warm and dry environment. Take off any wet, sweaty, or otherwise soiled clothing. Wear dry layers and warm the core. This means we want to preserve heat close to the body and organs. Use blankets, warm water bottles, and heating pads on the groin, chest, head, and around the neck. You can also use bedding or towels — anything you can to layer and provide heat.
Suppose conscious patients are talking to you and are aware of their surroundings. In that case, you can offer warm, non-alcoholic, non-caffeinated drinks. Alcohol and caffeine are dehydrating and shouldn’t be provided at this time. The person must remain hydrated and not intake anything that could weaken their ability to maintain body heat.
Frostbite: a cold weather threat
One of the consequences of untreated hypothermia can be frostbite. However, frostbite can also occur without one’s entire body temperature dropping. So, even if a person seems perfectly warm and has no outward signs of hypothermia, frostbite is still a risk.
Frostbite occurs when extremities like toes, fingers, nose, ears, and chin become damaged due to freezing. The skin may feel firm and initially have a white, gray-yellow hue. Eventually, the area becomes numb and can lose color, turning black as it dies off due to tissue death.
The key to preserving anatomy damaged by cold is to act before feeling tingling or numbness. Routinely inspect yourself to make sure that you can move all areas, that they aren’t changing color, and that you are warming the areas up often. Diabetics and those with poor circulation are at higher risk of this phenomenon than others.
As with hypothermia, we want to get someone experiencing potential frostbite out of the cold immediately. Bring affected individuals somewhere warm. Prevent walking on potentially frostbitten toes/feet or risk further damage. Place something between affected and non-affected digits, like a gauze. While instinctually one may want to rub the affected area, do not massage the area as this can cause more harm than good.
If emergency medical help isn’t immediately available, place affected structures in lukewarm (99–104ºF) but never hot water for more than 30 minutes. If it is too hot to touch on non-affected areas of the body, it is too hot for areas of concern. If medical care is further away, however, you do not want to have the areas cool down again and re-freeze. Therefore, other warming methods may be warranted. If warm water isn’t an option, warm the affected areas with other body parts, clothing, and even under the armpit.
Elevate frostbitten areas when feasible. Finally, when treating frostbite, never use:
- Heating pads
- Chemical heaters
- Feet warmers
Or related warming means on frostbite areas, as burns can happen easily and unknowingly.
No matter where you are, get medical care immediately while rewarming the person and the injured area.
6 steps to prevent hypothermia and frostbite
Generally, hypothermia occurs in temperatures < 40ºF (< 4.4ºC) and with extended periods in the elements without proper clothing or if wet, sweating, or sick. However, even in temperatures above this, if conditions are right, hypothermia can develop.
Taking proper care to ensure you remain well protected includes these 6 steps:
1. Plenty of sleep
Ensure you are well-rested before engaging in outdoor activities, especially in the cold. If already fatigued, one will tolerate the extremes for shorter time periods.
2. Proper hydration
Stay hydrated and pre-hydrate before going outside and before any heavy exercise.
3. Eat nutritiously
Proper nutrition and ensuring you eat enough before spending time outside in the cold, especially if you will be exercising, is key. We need carbohydrates and other food sources to make energy. When we are cold, our bodies need extra energy to stay warm. Remember, hypothermia is when we lose more heat than we produce, so we want to start with the building blocks we need to make energy.
4. Proper clothing and gear
The key to surviving the cold weather is to wear layers and keep your core warm at all times. You can always take layers off, but if you don’t have enough, you are already too late and out of luck. Wear sock liners and socks made of a warm material. If you will be hiking and may be sweating, try to choose materials that wick away sweat to keep you dry.
Avoid wet clothing and gear at all costs. If your clothing or footwear becomes wet, they should be changed/removed as soon as possible. We can survive longer in the cold weather when dry. Being wet will only accelerate the development of hypothermia.
5. Waterproof footwear
If your outdoor activities involve wet weather or the terrain has wet hazards, ensure your feet stay wet and dry. If your feet/shoes become wet, changing shoes may be the difference between frostbite and losing and saving a toe.
6. Keep your head covered
Keeping your head and ears covered can prevent losing heat from the top of the head (ear muffs/hat/scarf). This protects the head, keeps heat internal, and lessens the surface area for heat loss.
7. Protect your hands
Don’t be stubborn; thinking you don’t need gloves or mittens to keep your hands warm can lead to irreversible damage. The body, when cold, moves the blood away from our extremities to protect key organs like the heart, lungs, and brain. Consider chemical heat warmers in addition to mittens or gloves to protect your hands and fingers.
Additional preventative measures
Bad weather and power outages can happen without a moment’s notice. Ensure your loved ones have extra supplies of water (24–72 hours worth), warm clothing, and nutritious foods that can be eaten without cooking.
Make sure family members know where they can go to get out of the elements — be it a local shelter, a Red Cross shelter, or a known safe haven (often local fire departments or other government-designated facilities) — to lessen their chance of developing hypothermia and other extreme cold weather illnesses.
Planning prevents cold injuries
While some may prefer to curl up with a good book, watch a movie, or play games when temperatures dip below 40ºF, many enjoy outdoor activities from ice skating to rock climbing, hiking, snowboarding, or skiing. To ensure we not only revel in outdoor fun but do so safely, we can take precautions to help us prevent hypothermia and frostbite. Wear proper protective gear, stay hydrated, eat well, safeguard your head and extremities by keeping them well covered, and inspect yourself regularly to ensure no signs of cold weather illness are evident. If you or those with you show signs of hypothermia or frostbite, seek warmth immediately and get medical care as soon as possible.
Winter can be an enjoyable time for many, indoors and out. However, care must be taken when spending time outdoors in cold weather to prevent the onset of hypothermia.
Hypothermia — low body temperature — can cause confusion, weakness, shaking and uncontrollable shivering, memory loss, and, if untreated, can be deadly.
Older adults, those without proper heating and clothing, infants and young children, those with poor circulation, and those with underlying medical conditions are at higher risk of developing hypothermia.
Hypothermia prevention includes proper nutrition, remaining well-hydrated, proper protective clothing, and waterproof shoes to protect one’s core and head.
When extremities like the chin, nose, ears, feet, and hands are exposed to cold weather, frostbite can occur. If untreated, this can cause irreversible damage.
- Centers for Disease Control and Prevention. Prevent Hypothermia & Frostbite.
- USDA Forest Service. Hypothermia.
- NIH’s National Library of Medicine’s MedlinePlus. Frostbite.
- NIH’s National Library of Medicine’s MedlinePlus. How to prevent frostbite and hypothermia.
- NIH’s National Library of Medicine’s MedlinePlus. Hypothermia.
- National Safety Council. Avoid Frostbite and Hypothermia.