When to Perform First Aid vs Calling for Help & Special Considerations and Variations

Cold emergencies often occur in remote locations, making the decision about evacuation versus field treatment critical.

Call 911/Evacuate Immediately For:

Any Moderate/Severe Hypothermia:

- Core temp below 90°F - Shivering stopped - Confusion or altered mental state - Decreased consciousness - Slow or irregular pulse

Frostbite Requiring Evacuation:

- Any second-degree or deeper - Multiple digits affected - Face involvement - If refreezing likely - Combined with hypothermia

Environmental Factors:

- Continued exposure likely - Weather worsening - Darkness approaching - Injured person can't self-evacuate - Multiple victims

Can Provide Field Treatment If:

Mild Hypothermia Only:

- Still shivering - Alert and oriented - Can generate own heat - Shelter available - Improvement with treatment

Minor Frostbite (First-Degree):

- Small area affected - No blisters - Can prevent refreezing - Pain manageable - Medical care within hours

> Important Disclaimer: > Cold emergencies can deteriorate rapidly. Severe hypothermia requires extremely careful handling to prevent cardiac arrest. The decision to rewarm frostbite in the field depends on preventing refreezing. When in doubt, evacuate for professional medical care. This guide cannot replace wilderness first aid training for backcountry activities.

Evacuation Priorities:

1. Immediate: Unconscious, no shivering, severe frostbite 2. Urgent: Confused, moderate symptoms, facial frostbite 3. Soon: Mild symptoms not improving, risk of worsening 4. Monitor: Mild symptoms improving with treatment

Different scenarios and populations require modified approaches to cold injury management.

Cold Water Immersion:

Immediate Threats:

- Cold shock response (1 minute) - Swimming failure (10 minutes) - Hypothermia (30 minutes) - Post-rescue collapse

1-10-1 Principle:

- 1 minute to control breathing - 10 minutes of meaningful movement - 1 hour before unconsciousness

Rescue Considerations:

- Horizontal removal vital - Cardiac arrest risk high - Continue CPR longer - Submersion doesn't mean death - "Diving reflex" in children

Children and Cold:

Higher Risk Because:

- Larger surface area to mass ratio - Less subcutaneous fat - May not recognize danger - Can't generate heat as well - Dependent on adults

Special Considerations:

- Hypothermia develops faster - May have "miraculous" recoveries - Don't give up resuscitation - Diving reflex stronger - Keep searching in cold water

Elderly and Cold:

Increased Vulnerability:

- Decreased ability to sense cold - Medications affect thermoregulation - Less muscle mass for shivering - Often found indoors - Social isolation

Indoor Hypothermia:

- Common in elderly - Room temperature 60-65°F - Develops over days - Often missed - High mortality

Avalanche Victims:

Triple Threat:

- Asphyxiation - Trauma - Hypothermia

Survival Statistics:

- 15 minutes: 92% survival if airway clear - 35 minutes: 30% survival - 90 minutes: Near zero without air pocket

Treatment Priorities:

1. Establish airway 2. C-spine precautions 3. Prevent further cooling 4. Gentle handling 5. Extended CPR

Urban Cold Emergencies:

Homeless Population:

- Chronic cold exposure - Multiple medical issues - Substance abuse common - Delayed presentation - Need social services

Carbon Monoxide Risk:

- Space heaters - Running cars for warmth - Blocked vents - Combined with hypothermia - Check for CO exposure