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Hypothermia Treatment, Part Two: How to Treat an Unconscious Person

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
January 10th, 2012 | Category: Cold, Weather
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  • David Deitsch

    O.K., here is the answer to the riddle. It is a great illustration of how one has to “think outside the box” in wilderness and disaster medicine. The question was, “How do you get your patient into a tent without moving them again (which you always want to avoid in the hypothermic patient)?” The answer is simple: do not move the patient at all. Instead, erect a tent near them. Then, tip the tent over, and cut a slit in the tent floor a little longer than the patient (don’t forget to make the slit long enough to accommodate the “hypothermia sandwich” in which the patient is wrapped). Next, lift up the tent, position it over the patient, and lower it, pulling the slit tent floor aside to get the tent around the patient, and then tucking the edges of the tent floor under them. Too bad about the tent, but this is a life or death emergency, and you DO always have duct tape with you when you venture out, right?)

    • http://www.thesurvivaldoctor.com James Hubbard, M.D., M.P.H.

      Good idea, David. In situations like that, improvisation is the rule.

  • David Deitsch

    Thank you doc; great information.
    I thought that I would add what I was taught in Advanced Wilderness Life Support, for the consideration of yourself and your loyal readers.

    The best way to preserve body heat in an austere (wilderness or disaster) environment is to use hot packs, if available, as you recommend, remove any wet clothing (it is almost impossible to warm a patient who is wet) and then wrap the victim in three layers:

    A vapor barrier, which is a fancy term for anything water proof that you can wrap around the patient’s body. Trash bags, ponchos, ground cloths, car seat headliners or upholstery, or whatever else you can scrounge will work. Wrap the patient snugly (vapor barrier against their body with no air pockets), but avoid wrapping them tightly. You do not want to restrict breathing or circulation.

    Second, an insulating layer wrapped around the vapor barrier. Sleeping bags are great, but blankets, jackets, car seat cushions, crumpled paper, or even a thick layer of dry leaves or grass will work ina pinch. Make sure there is plenty of insulation under the patient, or they will lose a lot of heat to the ground by conduction.

    Finally, a windproof layer around the outside. Anything that wind cannot blow through will work.

    The best way to do this without moving the patient more than necessary is to lay-out all three layers, in proper order, on the ground at the patient’s head or feet, have assistants lift the patient GENTLY by their clothing, drag the three-layer “hypothermia sandwich” under them and wrap them up, one layer at a time. They are now ready for evacuation.

    However, I am going to leave you with a riddle. What if evacuation is impossible and you have to continue treatment in the field? How do you get your patient into a tent without moving them again (which you always want to avoid in the hypothermic patient)? If you or your readers are interested, I can post the answer to that riddle.

    • http://www.thesurvivaldoctor.com James Hubbard, M.D., M.P.H.

      Thanks for all the great info, David.

      I’d love to know the answer to your riddle.

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  • http://www.thesurvivaldoctor.com James Hubbard, M.D., M.P.H.

    Thanks for the info, Alice. I didn’t see it.

  • Alice Hudson, RN

    Had to chuckle when I watched “House” this week. A part of it dealt with a patient with hypothermia, and they used your motto, “they’re not dead until they’re WARM and dead.” LOL

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