Protocol Status: PUBLISHED
Protocol:
Version: 2026.01
Effective Date:
Last Reviewed:
Medical Director Approval:
Clinical Note: This content reflects current GCEMS clinical guidelines as of the dates listed above. If content appears inconsistent with current policy, use the most recent approved guideline and notify leadership for correction.

Hypothermia

 

History:

 

  • Past medical history
  • Medications
  • Exposure to environment even in normal temperatures
  • Exposure to extreme cold
  • Extremes of age
  • Drug use: alcohol/barbiturates
  • Infections/sepsis
  • Length of exposure/wetness

 

Significant Findings:

 

  • Cold/clammy
  • Shivering
  • Mental status changes
  • Extremity pain or sensory abnormality
  • Bradycardia
  • Hypotension or shock

 

Differential:

 

  • Sepsis
  • Environmental exposure
  • Hypoglycemia
  • CNS dysfunction
    • Stroke
    • Head injury
    • Spinal cord injury

 

Temperature ≤ 95⁰F (35⁰C) ?

 

  • No

 

    • See appropriate protocol based on symptoms

 

  • Yes

 

    • Handle very gently
    • Remove wet clothing
    • Apply hot packs and blankets
    • Determine Respiratory Rate
    • Oxygen
    • Obtain BGL
    • Initiate IV

 

 

Respiratory rate ≤ 4 bpm ?

 

  • Yes

 

    • Intubate and ventilate

 

Respiratory rate ≥4 bpm

 

  • Yes

 

    • Do not intubate, ventilate as necessary

 

 

Glucose ≤ 60 with signs of hypoglycemia ?

 

  • Yes

 

 

  • No

 

    • Notify receiving facility or contact Medical Control

 

PEARLS:

 

  • NO PATIENT IS DEAD UNTIL WARM AND DEAD!
  • Defined as core temperature less than 95⁰F (35⁰C).
  • Extremes of age are more susceptible (i.e., young and old).
  • With temperature less than 86⁰F (30⁰C) ventricular fibrillation is a common cause of death.  Handling patients gently may prevent this.
  • If the temperature is unable to be measured, treat the patient based on the suspected temperature.
  • Hypothermia may produce severe bradycardia so take at least 45 seconds to palpate a pulse.
  • Hot packs can be activated and placed in the armpit and groin area. Care should be taken not to place the packs directly against the patient's skin.
  • Intubation can cause ventricular fibrillation so it should be done gently by the most experienced person.
  • Do not hyperventilate the patient as this can cause ventricular fibrillation.
  • If the patient's temperature is less than 86⁰F (30⁰C) then only defibrillate one time if defibrillation is required.  Normal defibrillation procedure may resume once the temperature reaches 86⁰F (30⁰C).
  • Below 86⁰F (30⁰C) antiarrhythmics may not work and, if given, should be given at reduced intervals.
  • Below 86⁰F (30⁰C) pacing should not be done.