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Hypothermia Outline and Cold Water Immersion

A former member


Stages, Signs, Symptoms, & Treatment




Because the human brain requires such a delicate balance of pressure, oxygen, temperature, etc., noticing behavioral changes in yourself or others is one of the best ways to catch hypothermia early on.


It is very difficult to recognize hypothermia in oneself, and the further hypothermia advances, the less one is able to self-treat eventually getting to the point of not protecting oneself from the cold. This is why adequate preparation and group awareness are so important.


Being equipped with the right clothing—layers of non cotton and extra insulating long underwear, hat, and mittens—is another essential preventative measure.


Be prepared for surprise weather even in the spring and summer.


It is very difficult to recognize hypothermia in oneself, and the further hypothermia advances, the less one is able to self-treat, and eventually get to the point of not protecting oneself from the cold, which is why adequate preparation and good group awareness are so important.


Some Factors that Exacerbate Hypothermia: Dehydration, fatigue or exhaustion, being immobilized from a previous injury, and alcohol consumption.


** Never give alcohol—the fabled “shot of whiskey”—to a hypothermia victim. **



Mild Hypothermia Symptoms


  • Confusion
  • Loss of fine motor skills
  • Apathy
  • Pale, Cool Skin.


Moderate Hypothermia Symptoms


  • Slurred Speech
  • Uncontrolled Shivering
  • Increased Stumbling
  • Cold, Pale Skin


Treatment for Mild and Moderate Stages


  • Create a warm, dry environment for the patient
  • Change clothing even if they don’t seem wet (assume the clothing is wet)
  • Shivering in warm and dry insulation is far better than having an external heat source, such as a fire. **I demonstrated building a reflector shelter with a fire with wet clothing, partially to extend my own time being cold. I realize that it may not have been clear that changing into warm, dry clothing is the first and best treatment that will speed rewarming considerably.**
  • If using heat packs or hot water bottles to aid in rewarming avoid direct contact with the skin
  • Mild exercise that work the large muscle groups are good for the mild stage
  • For the moderate stage there may be too little coordination to exercise but sit-ups or isometric exercises can be done inside a sleeping bag.


Severe Hypothermia Symptoms


  • Shivering Stops (or may come in waves)
  • Rigid Muscles
  • Low Level of Consciousness
  • Cold and Bluish (cyanotic) Skin


Treatment for Severe Hypothermia


  • Same initial treatment as mild and moderate stages: Create a warm environment with dry, insulative clothing.
  • Treat the patient extremely carefully to prevent shocking the heart. Gently remove wet clothing and gently place victim in a hypothermia wrap.
  • Do not give food or liquids to a semi-conscious patient. There is a danger of airway obstruction.


The Hypothermia Wrap is a portable structure proven to provide the best rewarming environment. Always leave the victim’s face exposed.


  • Tarp (shell)
  • Foam Pad (ground insulation)
  • Zipped Sleeping Bag (ground insulation)
  • Open Bag (for victim)
  • Open Bag (placed on top of the victim then tarp is closed around)


Cold Water Immersion


The Cold Shock Response


The initial response to cold water is that blood in the capillaries cools very rapidly and rushes inward to the core of the body, to the heart, and causes gasping, hyperventilating, and tension. If this happens while your head is underwater, you’ve got a problem.


The shock usually lasts the first minute of exposure and if a person is able to relax, stay still, and slow his or her breathing the chances of survival are extended. Instead of battling to get out of the water in the first minute, let yourself adjust to the cold water, focus on not drowning, get your bearings, then calmly plan your exit from the water. (Maybe easier said than done, of course.)



In extreme cases, the cold shock response can cause cardiac arrest. This, “Immersion Syndrome” is rare and not completely understood but it is most likely connected to the rapid constricting of blood vessels (vasoconstriction) combined with inhaling frigid water.


Persons immersed in cold water should be treated gently, dried off, and insulated (hypothermia wrap) before being exposed to high external heat. In most cases, careful rewarming with the person’s own radiative heat is the first, best treatment.



How long can a person survive in cold water?


Water Temp Exhaustion/Unconsciousness Time of Survival



32.5° 45 Minutes


32.5 - 40° 15-30 Minutes 30- 90 Min.


40 – 50° 30 – 60 Minutes 1 – 3 Hours


60–70° 2 – 7 hours 2 – 40 hours


70–80° 3 – 12 hours 3 hours – indefinite


> 80° Indefinite Indefinite



Here are a couple of links to Cold Water Survival Sites:




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