4 February 2021

Treating Hypothermia

Hypothermia is becoming too cold. It can become very serious on the mountain or water. Generally whatever the other injuries are, such as broken arm, broken leg, broken back; your main concern is that your patient does not become cold. If they are cold (and becoming hypothermic) you need to re-warm them.

Click Here To See The Recognition Signs For Hypothermia


1. Stop sooner rather than later. Stop before the situation has spiraled into something very serious.

2. Find shelter out of the elements as much as possible. Behind a rock, into a gully, off the side of a spot height. You often get nicely out of the elements by moving a very short distance. You just need to know where to look - practice this with your lunch stops from now on.

3. If your patient is wet/damp (which they probably are) - strip them off fully, including underwear if wet. Obviously preserve their dignity; a storm shelter is good for this. Even though they will get colder in the short term - it is important they strip off fully, then get them into all the dry spare gear you carry. This is why spare pants/leggings are important to carry, not just spare fleece tops.

4. As well as finding mountain shelter, you can build shelter by getting into the storm shelter/kissu or making a tight barrier of bodies around your patient like a rugby scrum. If you only have a couple of bodies - put them standing between your patient and the wind direction.

5. With all these spare layers on your patient - you can make them work much better by ensuring everything is snug, tucked in tightly, all zips closed, all hoods up, cuffs closed. Their back should be to the wind/rain/snow. A neck scarf is good to cover their mouth and nose, so warm air they exhale is captured, and cold air they breath in is slightly warmed.

6. You should be carrying two foil blankets. Wrap these around your patient, inside their outer layers. Important the foil blankets are not just thrown over the shoulders, but sealed around your patient, inside their outer layers.

7. You should be carrying one survival bag/bivvy bag. Put your patient sitting, or lying, into this survival bag. Ideally someone else gets into survival bag with them. This begins to bring up temperature in the bag. Their head(s) stick out the top of bag. Without strangling them - seal the bag around their neck(s) to lock in as much body heat as possible.

8. Very important your patient is never sitting or lying directly on the ground, no matter how dry the ground. Body heat is sucked out of them into the ground. Even in a survival bag the ground still sucks out their body heat. So your patient, in their foil blankets and survival bag then sits or lies on backpacks - which insulate them off the ground. Worst case they could possibly lie across other peoples legs.

9. Food and drink. Ensure they are fully conscious, not sleepy/drowsy, with the possibility of choking on food. Even if not hungry/thirsty it is important to get fuel into them. Amounts little and often of good food such as brown bread sandwiches, and bad food such as chocolate/jellies. Both types of food are needed. Hot drink essential - hot ribena, hot mi wadi, herbal tea, regular tea - are all good. No coffee - it is no good for their compromised system - but they could hold a cup of coffee to warm their hands and breath in the warm vapor. No caffeine energy drinks, again bad for their system. No alcohol.

10. The emotional care you give is hugely important. They need to feel calmed, reassured, as relaxed as possible, that they are in calm/confident/competent hands. They do not need to overhear conversations about how quickly they are failing, how serious the situation is. They do not need to see anxious, stressed, whispered conversations going on across the spot height. I would nominate someone to sit with them, hold their hand and talk with them/reassure them. It is important to find the balance with not bombarding or exhausting them with talk and questions!

11. Get vital signs (pulse and breath) regularly, so you (or mountain rescue) have a picture as to whether they are getting better or worse. Write them down or type them into a phone.

12. Get allergies, medical issues, past medical history. Record it all. This is important in case your patient deteriorates; or if they suddenly have a fit - it is great to know in advance that they suffer from epilepsy for example.

13. Better to call for help too early rather than too late. Mountain Rescue would much rather you call them before the situation has become desperate. I find a good rule is, if you begin to wonder should you possibly call mountain rescue; then it is time you called them!

14. Calling for help; ring 112 or 999. Both are identical. With no phone reception try anyway. Your phone may well piggyback onto another network in the area that has reception. If you are the most experienced person, you will probably be dealing with your patient; so nominate someone also to make the emergency call.
A. You initially get through to central dispatch.
B. Ask for mountain rescue (ideally know who your local team are; for example in Kerry and Cork you are asking for Kerry Mountain Rescue).
C. You are transferred to the main garda station, where a guard will take some details, then hang up.
D. Your phone will ring with a member of the mountain rescue on the line to take it from there. This may take 5 to 20 mins before mountain rescue contact you.
E. Starting to happen with smart phone technology - is a text message also comes into your phone with an app you open, which gives you/mountain rescue your exact location.

15. When do you call for help? Completely depends on weather/location/distance from road/severity of patient/other injuries of patient/your level of emergency gear/your level of experience. Some people would call at the UMBLES stage. Some people would do full above treatment, wait and assess for 30-60 mins, then decide to call or to walk off hill with patient. Both can be correct - it is all down to your exact circumstances.

16. 30-60 mins after full above treatment you would hope to see patient coming back toward normal. I may not be in a rush to get moving again, but spend plenty of time in the survival bag and storm shelter. All going well your patient will tend to recover, however no matter how good they feel - it is time to use your escape route to get off hill, back to car and hot bath.

17. Heat pads can be used. They are not essential and I don't personally carry them. However they can be useful. Do not put them on hands/feet/arms/legs - this is dangerous. Put them as close to the body core as possible (and not touching the skin - have a layer of clothing between heat pad and skin). To get the heat pad close to body core place inside armpits, against stomach, against lower back, between thighs - right up in groin area. Watch they don't burn/scald your patient and watch they don't leak/burst.

18. Split Party? If one person has become hypothermic, chances are conditions have others in your party also at risk. There is no right or wrong answer to splitting your party. Sometimes it can be good for some of your party to continue on downhill to safety. Sometimes it is better to stay all together. You can imagine what a nuisance it becomes if some of your party continues on downhill; then gets lost, gets injured, or you discover they have gone off with an essential piece of first aid gear such as flask of hot tea, the spare clothes or the storm shelter...

19. No Reception? With no phone reception try anyway. Your phone may well piggyback onto another network in the area that has reception. A phone will make an emergency call even when locked/without pin code. With terrible reception/terrible weather conditions you can send an emergency sms text message to 112. You need to register your phone number with 112 first. Details here: www.112.ie/Sending_a_text_to_112/144.
With no reception whatsoever you move about, constantly trying to dial, and watching your signal bar icon. Do not get lost or walk off a cliff while doing this! Try different things - climb onto a boulder, climb onto a spot height, go into the middle of a saddle. With no reception still - you are heading downhill to the nearest house/road - like in the days before mobile phones. As you proceed keep checking your phone reception. This is why it is good to have an 'escape route' pre-planned as part of your route planning/route card. You want to be vigilant, as you are most likely rushing and stressed, that you do not become lost/injured/crag-fast.

20. Only One Rescuer? Less Than Three Should Never Be is a good rule of thumb. If one person becomes injured that leaves one person for perform first aid and one person to call for help/go for help. However if you are the only rescuer; you need to first stabilise your patient for the short term (no time consuming first aid yet - just make sure they are breathing, not bleeding heavily, not about to roll off a cliff or be swept away by a stream or avalanche). Then make the emergency call as quickly as possible. Then move into your proper first aid, getting out your gear, re-warming your patient. If you have no phone reception then you need to stabilise your patient, do your full first aid/re-warming/etc, then head off for help - noting the position of your patient.


Before completing your Mountain Skills Assessment you must have completed a first aid course. Remote Emergency Care is a great scheme. A two-day REC2 course is fine; or a three-day REC3 course is even better. I highly recommend Marie Lyons of Remote West First Aid.


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