Shivering, slurred speech, and unsteady walking are signs of hypothermia; change into dry clothes, wrap up, warm the torso first, and give sweet hot drinks instead of alcohol

28. Shivering, slurred speech, and unsteady walking are signs of hypothermia; change into dry clothes, wrap up, warm the torso first, and give sweet hot drinks instead of alcohol

Cost: An emergency thermal blanket costs just a few dollars, plus a spare dry set of clothes. Learning to recognize the warning signs costs nothing.

In plain terms: When body temperature drops below 35°C, hypothermia sets in. Victims start to shiver, speak unclearly, walk unsteadily, and have trouble thinking. Remove any wet clothing and wrap the person in a thermal blanket or dry clothes, making sure to warm the torso before the limbs. Offer sweet hot drinks, but avoid alcohol — it suppresses shivering. The absence of shivering does not mean improvement; it actually signals worsening condition. If the person loses consciousness, begin CPR immediately.

Benefit: According to the U.S. National Weather Service, any body temperature below 95°F (35°C) indicates hypothermia, and symptoms such as feeling cold, sluggishness, and confusion warrant immediate medical attention. Recommended actions include moving the victim to a warm indoor environment, focusing on warming the core first, and providing hot drinks. Alcohol is discouraged because it reduces shivering. CPR is required if the person becomes unconscious. Warm water or body heat can be used to treat frostbite, but avoid hot water or direct radiant heat sources like fireplaces. The Wilderness Medical Society’s 2019 hypothermia guidelines serve as the authoritative clinical reference on this topic.

Evidence grade: B

Sources: US National Weather Service. During Extreme Cold. <https://www.weather.gov/safety/cold-during>; Dow J et al. (2019). Wilderness Medical Society Clinical Practice Guidelines for the Out-of-Hospital Evaluation and Treatment of Accidental Hypothermia: 2019 Update. Wilderness & Environmental Medicine. <https://doi.org/10.1016/j.wem.2019.10.002>

Notes: Do not rub or massage the limbs to warm them. Avoid hot baths at all costs. Do not drag or force‑move a severely hypothermic person — their heart may stop unexpectedly. Remember, the absence of shivering is not a sign of recovery; it often means the condition is worsening. Full access to the Wilderness Medical Society’s guideline requires a subscription; this translation is based solely on its summary.