Risk & Rescue
Hypothermia: recognising it in someone who says they are fine
The dangerous stage arrives before anyone is dramatically cold, and its main symptom is that the affected person stops being able to assess themselves.
Hypothermia does not usually announce itself. There is no dramatic moment. Someone gets gradually quieter, gets a bit clumsy, insists they are fine, and by the time the group notices, that person has lost the ability to make sensible decisions about their own situation.
That is the crux of it: the condition impairs exactly the faculty needed to recognise the condition. Which means it will always be spotted by somebody else, or not at all.
It does not require extreme cold
The classic setting is not a blizzard. It is a wet, windy day somewhere around freezing or a bit above, on someone who is tired, underfed, dressed in something that got damp, and no longer generating much heat because they have slowed down.
Wind and water are the accelerants. Moving air strips heat from skin far faster than still air, and wet clothing conducts heat away many times faster than dry. Immersion is faster again — cold water pulls heat out of a body at a rate that dry air simply cannot match.
The progression, in terms you can observe
Early. Shivering, which is the body's heat production working as designed. Cold hands and feet. Some clumsiness with fine tasks — zips, buckles, gloves. The person is still fully with you and can help themselves.
Moderate. Shivering becomes violent, then — importantly — begins to stop. Slurred or mumbled speech. Stumbling, poor coordination. Confusion, apathy, unusual quietness, or oddly poor decisions. Withdrawal from the group.
This is the stage that matters most, because shivering stopping is often misread as improvement. It is the opposite: it means the body can no longer sustain heat production.
Severe. No shivering, rigid muscles, very reduced consciousness, slow and shallow breathing, a pulse that may be hard to find. This is a life-threatening emergency requiring evacuation and extremely careful handling.
The behavioural tells
In the field you will rarely have a thermometer, so watch behaviour.
The strongest single indicator is a change in character. The talkative person who has gone silent. The competent person fumbling with a buckle they have used a thousand times. Someone who says "I'm fine" flatly, without engaging, or who wants to sit down and rest in an exposed place.
A practical field check: ask them to walk a straight line heel to toe for a few metres, or answer a question requiring a bit of thought — not their name, but something like counting backwards. Someone who cannot do it needs intervention now, whatever they say about how they feel.
What to do
Stop the heat loss first. This is more urgent than adding heat. Get out of the wind — behind a rock, into a shelter, into a bothy bag. Remove wet layers and replace with dry ones. Insulate from the ground, which drains heat fast; a sleeping mat or a pack under them is essential.
Then add heat. Warm sweet drinks and food if they are alert enough to swallow safely. A hot water bottle or warm packs at the chest, armpits and groin. Another person's body heat inside a shared bag works and is often all you have.
Fuel matters. Shivering is muscular work and it burns through blood sugar. Someone who has not eaten cannot shiver effectively. Sugary food is genuinely medical here.
Things that make it worse
Alcohol — it dilates surface vessels and increases heat loss while making the person feel warmer.
Rubbing cold limbs vigorously, or plunging them into hot water.
Moving a severely hypothermic person roughly. A very cold heart is electrically unstable and rough handling can trigger a fatal rhythm. Handle gently, keep them horizontal, do not encourage them to walk or exert themselves.
Assuming they can decide for themselves. They cannot. If someone is moderately hypothermic, you make the decisions on their behalf, firmly and kindly, including the decision to stop and shelter when they want to push on.
Prevention, which is nearly the whole thing
Carry a spare warm layer that stays dry. Put insulation on the moment you stop rather than after you cool. Eat before you are hungry. Keep a group emergency shelter — a bothy bag is the single highest-value item for its weight in cold, wet mountains.
And check on people. Ask the quiet one at the back a direct question and listen to how they answer. In nearly every incident report there is a point where someone noticed that a member of the group had gone quiet and did not act on it for another hour.
