Life-Saving Training Blog

 

How to Teach Cold Weather First Aid

by  Bob Elling     Jan 8, 2026
cold-weather-first-aid-training

Each morning, I check the weather app on my phone to see the temperature outside: where I live, where my kids live, and a couple of my favorite locations.

One morning, I found the following: 

  • Here in Crystal River, FL it was 43° going up to 65°

  • Washington, DC it was 21° going up to 37°

  • Rochester, NY it was 8° going up to 32°

  • Lake Placid, NY (my previous home) it was -6° going up to 20°

  • Key West, FL (my favorite spot) it was 73° going up to 76°

The impressive number is the impact of the wind gusts on the temperature which can push it down 10 or more degrees and freeze exposed skin in minutes. 

Winter has arrived. Get out the layers, a puffy coat, and a wool hat. But the good news is, the days will start getting longer.

If you haven’t already, it is time to review first aid for those Winter Emergencies.  

Some Interesting Data 

  • According to the CDC, “in 2023 a total of 1,024 deaths were attributed to excessive cold or hypothermia. The majority of death occurred during January-February and November-December, with the highest percentage occurring in January (19.9%).”

  • According to NOAA, in the USA, the only state that has not seen a subzero temperature is Hawaii where the coldest temperature recorded was 12°.

  • The coldest temperature was in Alaska when it plummeted to -80° in Prospect Creek, AK (1/23/71).

  • The coldest temperature recorded in the contiguous U.S. is -70° degrees measured at Rogers Pass, MT (1/20/54).

  • The oldest record, of -50° was recorded on Mount Washington, NH, the highest peak in the Northeast (1/22/1885). 

Present a Case: Start with a Likely Scenario  

When teaching cold weather first aid, it is helpful to start discussing a case that everyone can relate to and make your points. Here are some examples of cold weather scenarios you may have responded to over the years: 

  • There was light rain all afternoon, then the temps started dropping and the wind picked up. As the daylight faded to evening darkness, it started to snow, lightly covering the roads but not enough for the plows and sanders to be out in force yet. These are dangerous driving conditions as the light snow is simply covering the icy roads. The combination of the wet roads, dropping temperatures, increasing winds, and snowfall turn the situation from rushing home on a rainy day to trying to break on sheets of ice! How about a motor vehicle crash where the driver in a rush hit the break and went off the road, down the embankment and crashed into a tree? His initial injuries may not have been life-threatening but being stranded in the cold vehicle overnight could contribute considerably.

  • Going for a short hike just outside of town. Always check the weather and carry extra layers and a rain jacket. Bring a map, flashlight, plenty of water, some snacks, and some first aid supplies. Have a plan where you are going and make sure someone you trust knows where you are off to. If the hikers have not put in place a simple plan, things can get messy quickly. When the weather suddenly changes (cooler, wetter, windy, lightening), anxiety and disorientation can also set in leading to injuries and inappropriate decisions.  By the way, does your cell phone have service during a storm?

  • On a chilly day with light snow in the air, Grandpa walked out to “just get the mail” from the mailbox, in his PJs. He slipped on the ice and fell, breaking his hip. It was a school day so there were no kids around and most of the neighbors were at work. He lays there on the hard, cold ground for a couple of hours till a passerby finally notices him. Be sure to consider assessment of the injury sustained as well as the possibility of his medical history as a contributing factor in the fall. Don’t forget to consider the implications of heat loss through conduction due to lying on the cold ground for so long.

  • You are dispatched to the home of an elderly couple. Mrs. Smith called because her husband of 50 years seemed weak and confused. Mr. Smith has a long history of heart disease and diabetes. She mentions that they can barely afford the medicines he is supposed to take each day. You notice the house has a large fireplace, but no firewood pile. During your assessment you realize that you and your partner arrived with a heavy winter coat on and 10 minutes later you are still chilly with your coats on. Sometimes during difficult economic times, families on fixed incomes have to make difficult decisions to pay their bills. They may skip meals or wear a sweater and turn down the heat in their home. Remember to check his temperature!

  • Kids love the snow… building a snowman, snow fort, snow angels, riding sleds on that hill in the park, having a snowball fight, or shoveling the walk (NOT). It’s all good clean fun when paired with some adult supervision. Kids need to be dressed in layers so they stay warm. Good gloves, a warm hat, and dry boots. Stay away from the cars, plows, and bodies of water that may be covered by snow…(aka: the backyard pool)! They also need to take warmup breaks or they will simply play till exhaustion and/or hypothermia clouds their “judgement.”   

What is Hypothermia?

Hypothermia is a life-threatening condition in which the body’s core temperature falls below 95°F (35°C). A healthy person, without risk factors, can endure exposure to cold temperature by shivering to generate body heat. However, wet skin and the wind can accelerate loss of body heat. As the body’s ability to generate heat is surpassed by the body’s loss of heat, the core temperature will begin to drop. The difference between mild, moderate, and severe hypothermia is based on the measurement of the core body temperature. That means you would need an accurate thermometer designed to detect low temperatures, and not the oral thermometer used to detect a fever. These thermometers are usually rectal thermometers and drop down below 90°F (34.4°C). Assessment of hypothermia includes: an altered mental status, shivering or no shivering, a cold abdomen, and a low core body temperature. 

Risk Factors for Hypothermia 

It is helpful to know the risk factors that can increase the likelihood of your patient having hypothermia.  Consider the following:

  • Exhaustion: Fatigue reduces a person's ability to tolerate cold.

  • The Elderly Population: The body's ability to regulate temperature and to sense cold may lessen with age. And some older adults may not be able to tell someone when they are cold or to actually move to a warmer location if they do feel cold. They may have limitations due to physical or mental or medical issues.

  • The Very Young Population: Children lose heat faster than adults do. The head is a large surface area that should be covered in the cold weather. Children also may ignore the cold because they're having too much fun to think about it. They may not have the judgment to dress properly in cold weather or to get out of the cold when they should.

  • Preexisting Mental Health Conditions: People with a mental illness, dementia or other conditions that interfere with judgment may not dress properly for the weather or understand the risk of cold weather. People with dementia may wander from home or get lost easily, making them more likely to be stranded outside in cold or wet weather.

  • Alcohol and/or Drug Use: Alcohol may make the body feel warm inside, but it causes blood vessels to expand. As a result, the surface of the skin loses heat more rapidly. Alcohol also reduces the body's natural shivering response which is designed to create heat. Intoxicating substances can affect judgment about the need to get inside or wear appropriate clothes in the cold-weather. If an intoxicated patient passes out in cold they are likely to develop hypothermia.

  • Medical Conditions and/or Injuries: Health disorders can affect the body's ability to regulate body temperature (ie; hypothyroidism, poor nutrition, diabetes, stroke, severe arthritis, Parkinson's disease, and trauma.

  • Medicines the Patient Takes: Some drugs change the body's ability to regulate its temperature (ie: antidepressants, antipsychotics, narcotic pain medicines, and sedatives). 

Management of Hypothermia 

Regardless of the suspected severity of hypothermia, generally the patient should be treated as follows: 

  • Get the patient out of the cold. Treat hypothermia before treating frostbite.

  • Handle the patient gently. Rough handling can precipitate cardiac arrest.

  • Replace wet clothing with dry clothing once protected from the cold environment.

  • Add insulation beneath and around the patient (ie: blankets, towels, pillows). Cover the patient’s head with a warm cap.

  • Consider a vapor barrier to hold the patient’s heat in.

  • If CPR is needed, remember that it will take a long time to achieve ROSC. Defib as needed, but it may not be effective, nor will drug therapy till the core of the body is slowly warmed up. This is one of those times where the Mechanical CPR device will be very helpful and if the ED doesn’t have one, they may want to use your ambulance service’s.

  • As always follow your local/regional treatment protocols. 

What is Frostbite? 

Freezing of the skin and its layers is called frostbite and occurs in below-freezing temperatures (usually about 28°F (-2.2°C) or less). The tissue is damaged by the formation of ice crystals which damage the cells and the obstruction of blood supply to the tissue. In severely cold temperatures flesh can freeze in less than a minute. Frostbite mainly affects the feet, hands, ears, and nose since these areas are not well protected unless the proper clothing is worn.

Management of Frostbite 

The key issue of concern is whether to defrost or not. Once the tissue has frozen, damage has occurred. Defrosting and then allowing tissue to refreeze can be significantly worse. Therefore, if treatment involves rewarming (defrosting) in the field, it must include assuring that the defrosted tissue will stay defrosted. In many situations, this is a local EMS System decision based on travel distance and hospital capabilities. Discuss this with your Service Medical Director and follow your local/regional protocols. 

If the decision is made to thaw the frozen tissue in warm (never hot) water, the tissue may blister and discolor as a burn injury. Remove rings as swelling will occur and cover with a clean cloth. Do not let the patient walk on a frostbitten foot and do not break blisters. Expect as circulation comes back into the tissue, it will be very painful. Keep the thawed injury from refreezing. 

Some Tips to Include in Your Winter First Aid Training 

  • If you need a jacket at this motor vehicle crash, so does the patient, or at least a warm blanket!

  • If the patient is wet and cold, they need to be moved out of the cold and dried and warmed.

  • Anyone who falls overboard or into a “covered” pool and is rescued should be considered as a hypothermia victim. All water is cold water unless you fall asleep in a hot tub.

  • If you are inside someone’s home for a call and need to keep your coat on, consider if it is too cold inside. Some people on “fixed” incomes have to make difficult choices in the winter (eat vs. heat). For your differential diagnosis of a patient with an altered mental status keep hypothermia on the short list!

  • If someone is found roaming around the neighborhood with shorts and a tee shirt and you have a coat on and note he is not shivering, take his temperature!

  • Seriously consider “winterizing” your personal vehicle (ie: blankets, first aid kit, flashlight and working batteries, warm jacket, snacks, spare phone charger) and not just snow tires and anti-freeze.  Need a good reason? Remember that severe snowstorm which left hundreds of drivers stranded as the Virginia Department of Transportation shut down part of the interstate from 5:30pm till 7:00pm the next day.

Resources

About the Author: 

Bob Elling, MPA, Paramedic (retired) – has been a career paramedic, educator, author, and EMS advocate for 5 decades. He was a paramedic with the Town of Colonie EMS Department, Albany Times Union Center, and Whiteface Mountain Medical Services. He was also an Albany Medical Center Clinical Instructor at the HVCC Paramedic Program. Bob served as AHA National/Regional Faculty and participated in many successful life-saving legislative campaigns with the You’re the Cure Network. He also served as paramedic and lieutenant for New York City EMS, a paramedic program director, and associate director of New York State EMS Bureau. He has authored hundreds of articles, videos, blogs, and textbooks to prepare EMS providers for their career. Bob is the ECSI Series Editor for the CPR and First Aid books, Co-Author of EVOS-2, and Co-Lead Editor of Nancy Caroline’s Emergency Care in the Streets. 

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How to Teach Cold Weather First Aid

by  Bob Elling     Jan 8, 2026
cold-weather-first-aid-training

Each morning, I check the weather app on my phone to see the temperature outside: where I live, where my kids live, and a couple of my favorite locations.

One morning, I found the following: 

  • Here in Crystal River, FL it was 43° going up to 65°

  • Washington, DC it was 21° going up to 37°

  • Rochester, NY it was 8° going up to 32°

  • Lake Placid, NY (my previous home) it was -6° going up to 20°

  • Key West, FL (my favorite spot) it was 73° going up to 76°

The impressive number is the impact of the wind gusts on the temperature which can push it down 10 or more degrees and freeze exposed skin in minutes. 

Winter has arrived. Get out the layers, a puffy coat, and a wool hat. But the good news is, the days will start getting longer.

If you haven’t already, it is time to review first aid for those Winter Emergencies.  

Some Interesting Data 

  • According to the CDC, “in 2023 a total of 1,024 deaths were attributed to excessive cold or hypothermia. The majority of death occurred during January-February and November-December, with the highest percentage occurring in January (19.9%).”

  • According to NOAA, in the USA, the only state that has not seen a subzero temperature is Hawaii where the coldest temperature recorded was 12°.

  • The coldest temperature was in Alaska when it plummeted to -80° in Prospect Creek, AK (1/23/71).

  • The coldest temperature recorded in the contiguous U.S. is -70° degrees measured at Rogers Pass, MT (1/20/54).

  • The oldest record, of -50° was recorded on Mount Washington, NH, the highest peak in the Northeast (1/22/1885). 

Present a Case: Start with a Likely Scenario  

When teaching cold weather first aid, it is helpful to start discussing a case that everyone can relate to and make your points. Here are some examples of cold weather scenarios you may have responded to over the years: 

  • There was light rain all afternoon, then the temps started dropping and the wind picked up. As the daylight faded to evening darkness, it started to snow, lightly covering the roads but not enough for the plows and sanders to be out in force yet. These are dangerous driving conditions as the light snow is simply covering the icy roads. The combination of the wet roads, dropping temperatures, increasing winds, and snowfall turn the situation from rushing home on a rainy day to trying to break on sheets of ice! How about a motor vehicle crash where the driver in a rush hit the break and went off the road, down the embankment and crashed into a tree? His initial injuries may not have been life-threatening but being stranded in the cold vehicle overnight could contribute considerably.

  • Going for a short hike just outside of town. Always check the weather and carry extra layers and a rain jacket. Bring a map, flashlight, plenty of water, some snacks, and some first aid supplies. Have a plan where you are going and make sure someone you trust knows where you are off to. If the hikers have not put in place a simple plan, things can get messy quickly. When the weather suddenly changes (cooler, wetter, windy, lightening), anxiety and disorientation can also set in leading to injuries and inappropriate decisions.  By the way, does your cell phone have service during a storm?

  • On a chilly day with light snow in the air, Grandpa walked out to “just get the mail” from the mailbox, in his PJs. He slipped on the ice and fell, breaking his hip. It was a school day so there were no kids around and most of the neighbors were at work. He lays there on the hard, cold ground for a couple of hours till a passerby finally notices him. Be sure to consider assessment of the injury sustained as well as the possibility of his medical history as a contributing factor in the fall. Don’t forget to consider the implications of heat loss through conduction due to lying on the cold ground for so long.

  • You are dispatched to the home of an elderly couple. Mrs. Smith called because her husband of 50 years seemed weak and confused. Mr. Smith has a long history of heart disease and diabetes. She mentions that they can barely afford the medicines he is supposed to take each day. You notice the house has a large fireplace, but no firewood pile. During your assessment you realize that you and your partner arrived with a heavy winter coat on and 10 minutes later you are still chilly with your coats on. Sometimes during difficult economic times, families on fixed incomes have to make difficult decisions to pay their bills. They may skip meals or wear a sweater and turn down the heat in their home. Remember to check his temperature!

  • Kids love the snow… building a snowman, snow fort, snow angels, riding sleds on that hill in the park, having a snowball fight, or shoveling the walk (NOT). It’s all good clean fun when paired with some adult supervision. Kids need to be dressed in layers so they stay warm. Good gloves, a warm hat, and dry boots. Stay away from the cars, plows, and bodies of water that may be covered by snow…(aka: the backyard pool)! They also need to take warmup breaks or they will simply play till exhaustion and/or hypothermia clouds their “judgement.”   

What is Hypothermia?

Hypothermia is a life-threatening condition in which the body’s core temperature falls below 95°F (35°C). A healthy person, without risk factors, can endure exposure to cold temperature by shivering to generate body heat. However, wet skin and the wind can accelerate loss of body heat. As the body’s ability to generate heat is surpassed by the body’s loss of heat, the core temperature will begin to drop. The difference between mild, moderate, and severe hypothermia is based on the measurement of the core body temperature. That means you would need an accurate thermometer designed to detect low temperatures, and not the oral thermometer used to detect a fever. These thermometers are usually rectal thermometers and drop down below 90°F (34.4°C). Assessment of hypothermia includes: an altered mental status, shivering or no shivering, a cold abdomen, and a low core body temperature. 

Risk Factors for Hypothermia 

It is helpful to know the risk factors that can increase the likelihood of your patient having hypothermia.  Consider the following:

  • Exhaustion: Fatigue reduces a person's ability to tolerate cold.

  • The Elderly Population: The body's ability to regulate temperature and to sense cold may lessen with age. And some older adults may not be able to tell someone when they are cold or to actually move to a warmer location if they do feel cold. They may have limitations due to physical or mental or medical issues.

  • The Very Young Population: Children lose heat faster than adults do. The head is a large surface area that should be covered in the cold weather. Children also may ignore the cold because they're having too much fun to think about it. They may not have the judgment to dress properly in cold weather or to get out of the cold when they should.

  • Preexisting Mental Health Conditions: People with a mental illness, dementia or other conditions that interfere with judgment may not dress properly for the weather or understand the risk of cold weather. People with dementia may wander from home or get lost easily, making them more likely to be stranded outside in cold or wet weather.

  • Alcohol and/or Drug Use: Alcohol may make the body feel warm inside, but it causes blood vessels to expand. As a result, the surface of the skin loses heat more rapidly. Alcohol also reduces the body's natural shivering response which is designed to create heat. Intoxicating substances can affect judgment about the need to get inside or wear appropriate clothes in the cold-weather. If an intoxicated patient passes out in cold they are likely to develop hypothermia.

  • Medical Conditions and/or Injuries: Health disorders can affect the body's ability to regulate body temperature (ie; hypothyroidism, poor nutrition, diabetes, stroke, severe arthritis, Parkinson's disease, and trauma.

  • Medicines the Patient Takes: Some drugs change the body's ability to regulate its temperature (ie: antidepressants, antipsychotics, narcotic pain medicines, and sedatives). 

Management of Hypothermia 

Regardless of the suspected severity of hypothermia, generally the patient should be treated as follows: 

  • Get the patient out of the cold. Treat hypothermia before treating frostbite.

  • Handle the patient gently. Rough handling can precipitate cardiac arrest.

  • Replace wet clothing with dry clothing once protected from the cold environment.

  • Add insulation beneath and around the patient (ie: blankets, towels, pillows). Cover the patient’s head with a warm cap.

  • Consider a vapor barrier to hold the patient’s heat in.

  • If CPR is needed, remember that it will take a long time to achieve ROSC. Defib as needed, but it may not be effective, nor will drug therapy till the core of the body is slowly warmed up. This is one of those times where the Mechanical CPR device will be very helpful and if the ED doesn’t have one, they may want to use your ambulance service’s.

  • As always follow your local/regional treatment protocols. 

What is Frostbite? 

Freezing of the skin and its layers is called frostbite and occurs in below-freezing temperatures (usually about 28°F (-2.2°C) or less). The tissue is damaged by the formation of ice crystals which damage the cells and the obstruction of blood supply to the tissue. In severely cold temperatures flesh can freeze in less than a minute. Frostbite mainly affects the feet, hands, ears, and nose since these areas are not well protected unless the proper clothing is worn.

Management of Frostbite 

The key issue of concern is whether to defrost or not. Once the tissue has frozen, damage has occurred. Defrosting and then allowing tissue to refreeze can be significantly worse. Therefore, if treatment involves rewarming (defrosting) in the field, it must include assuring that the defrosted tissue will stay defrosted. In many situations, this is a local EMS System decision based on travel distance and hospital capabilities. Discuss this with your Service Medical Director and follow your local/regional protocols. 

If the decision is made to thaw the frozen tissue in warm (never hot) water, the tissue may blister and discolor as a burn injury. Remove rings as swelling will occur and cover with a clean cloth. Do not let the patient walk on a frostbitten foot and do not break blisters. Expect as circulation comes back into the tissue, it will be very painful. Keep the thawed injury from refreezing. 

Some Tips to Include in Your Winter First Aid Training 

  • If you need a jacket at this motor vehicle crash, so does the patient, or at least a warm blanket!

  • If the patient is wet and cold, they need to be moved out of the cold and dried and warmed.

  • Anyone who falls overboard or into a “covered” pool and is rescued should be considered as a hypothermia victim. All water is cold water unless you fall asleep in a hot tub.

  • If you are inside someone’s home for a call and need to keep your coat on, consider if it is too cold inside. Some people on “fixed” incomes have to make difficult choices in the winter (eat vs. heat). For your differential diagnosis of a patient with an altered mental status keep hypothermia on the short list!

  • If someone is found roaming around the neighborhood with shorts and a tee shirt and you have a coat on and note he is not shivering, take his temperature!

  • Seriously consider “winterizing” your personal vehicle (ie: blankets, first aid kit, flashlight and working batteries, warm jacket, snacks, spare phone charger) and not just snow tires and anti-freeze.  Need a good reason? Remember that severe snowstorm which left hundreds of drivers stranded as the Virginia Department of Transportation shut down part of the interstate from 5:30pm till 7:00pm the next day.

Resources

About the Author: 

Bob Elling, MPA, Paramedic (retired) – has been a career paramedic, educator, author, and EMS advocate for 5 decades. He was a paramedic with the Town of Colonie EMS Department, Albany Times Union Center, and Whiteface Mountain Medical Services. He was also an Albany Medical Center Clinical Instructor at the HVCC Paramedic Program. Bob served as AHA National/Regional Faculty and participated in many successful life-saving legislative campaigns with the You’re the Cure Network. He also served as paramedic and lieutenant for New York City EMS, a paramedic program director, and associate director of New York State EMS Bureau. He has authored hundreds of articles, videos, blogs, and textbooks to prepare EMS providers for their career. Bob is the ECSI Series Editor for the CPR and First Aid books, Co-Author of EVOS-2, and Co-Lead Editor of Nancy Caroline’s Emergency Care in the Streets. 

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