These notes are for guidance only - hillwalkers are advised to attend a Mountain First Aid course [Search]. These notes are copyright © Ian Roy, 1992 and are reproduced here with permission from Boots Across Scotland. I have tried to stay as close as possible to the original text adding only where I thought appropriate.

Cold Wet Killer

Mountain Hypothermia Exhaustion Exposure is a frequent and potentially dangerous problem faced by Scottish mountain walkers at any time of the year - most often when the temperature is well above freezing point. Many walkers have experienced the early warning symptoms and escaped more serious consequences without realising how closely they had flirted with tragedy. Exhaustion Exposure is a result of the combined effects of cold, wet and wind and is always associated with exhaustion and low morale caused by walking too far, too fast, carrying too heavy a load, when hungry and wearing poor clothing protection from wind and rain.

In these conditions the walker is being chilled so thoroughly that his body is losing heat faster than his body can produce it from food or through muscle exercise. In the early stages this heat loss affects only the body's outer shell (face and limbs). Exposed flesh of face, hands and legs will quickly become almost as cold as the surrounding environment. This is NOT a sign of hypothermia, but DOES mean that heat is being drawn away from the vital body core (head, chest, abdomen). The body core temperature has to fall from its normal 37C by only 2C to cause real hypothermia problems. This temperature will continue to fall to the life-threatening level of 28C unless the problem is recognised quickly and effective measures taken without delay to prevent further heat loss. The time from initial onset of hypothermia to death can be less than two hours.


Mountain Hypothermia is 100% preventable in fit, healthy walkers providing you follow four simple rules:

  1. Eat sufficient energy-producing food before and during the walk, making regular stops at least every hour to eat and drink or keep nibbling as you go.
  2. Wear proper wind and waterproof clothing to protect you from head to toes, using insulating layers for best protection.
  3. Attempt only what you know you can physically achieve. Beware of enthusiastic group leaders who push you too far!
  4. Be keen and eager to do what you are attempting. Stick to realistic goals. Keep cheerful. Be willing to stop or turn back if you think you've tried too much.


  • If you get lost and are caught out overnight;
  • If you are injured or taken suddenly ill;
Others most at risk include children and adolescents, the elderly, diabetics, walkers with heart conditions and some conditions needing regular medication.


There are four stages of treatment depending on how quickly you recognise the problem and severity of casualty's coldness.

Stage 1 Preventable
Most effective way of combatting the cold exposure environment. Eating and drinking sufficient energy giving food and drink. Wearing proper protective wind and waterproof clothing. Not squandering energy by attempting too much or fighting strong winds. Knowing when to stop and get off the mountains.
Stage 2 Reversible
Feeling cold and unhappy. Importance of recognising early warning signs cannot be over emphasised so that action can be taken to reverse effects.
AIM: To prevent further body heat loss.
  • Stop and shelter from wind and rain.
  • Stoke up body's fuel with fast acting hot sweet drink and food Twix, choclolate, mint cake, glucose sweets, raisins, nuts, dried fruit, etc.
  • Take ten minute rest sitting on insulating mat or rucksack, put on extra clothing especially for head and hands. Discuss and decide either to continue, escort off or consider stage 3.
Stage 3 Rescuable
Feeling extremely cold 'chilled to the bone' but is still conscious can think and talk coherently.
AIM: Prevent body heat loss, protect from weather.
  • Lay down on insulating sit mats in sleeping bag or wrapped in spare clothing and within weather cocoon of polythene bag. (foil space bags are useless in mountain hypothermia situation). If no other protection available, some shelter can be provided by lying on ground cuddled between two other members of the party.
  • Effective rewarming comes only from INSIDE casualty. Give warm sweet drink and glucose-based food if able to swallow to build up body's heat making energy source.
  • Warm the air the casualty is breathing by winding wollen scarf loosly round casualty's mouth and nose - simple but effective heat/moisture exchange could save life.
  • After 20 minutes discussion and observation decide if able to evacuate casualty or if rescue is needed. If in shelter, assist casualty to remove heavy wet outer clothing and replace with warm dry clothing.
Stage 4 Critical
Deeply cold. "Body feels cold as marble". Armpit is really cold. Confused, lapsing into unconsciousness.
AIM: Shelter protection. No unnecessary movement.
  • Place casualty on side in recovery position, head low to maintain open airway, on insulating sit mats in sleeping bags within weather cocoon of polythene bag. Send for rescue without delay.
  • Keep close check on Airway, Breathing, Circulation. Feel for full minute when checking pulse. If breathing stops turn casualty onto back and blow air into his mouth, one breath every six seconds, until breathing restarts. Remember to keep his head back. If heart stops begin CPR. only if you were there when heart stopped and you can continue CPR for arrival in hospital within two hours (otherwise CPR is useless, and exhausted helpers would be at risk).

NEVER presume death of cold casualty.


Signs and effects of Exhaustion Exposure are insidious and the early warning signs are often unnoticed by other members of the group. The casualty is usually the last person to realise that something is going wrong.


  • Be aware of the problem of Exposure Exhaustion.
  • Know the warning signs to look out for.
  • Recognise the warning signs as they appear.
  • In poor weather a close but discrete watch must be kept on other group members. Group Leaders have particular responsibility here, but everyone else should be on the alert.


  • Feeling cold and unhappy;
  • Complaining and grumbling;
  • Slowing down or lagging behind;
  • Difficulty crossing rough ground;
  • Slowing mentally and physically;
  • Slurring of speech;
  • Poor coordination (knots zips etc.);
  • Spells of shivering when resting;
  • Cramps in legs


  • Feeling bitterly cold and stiff;
  • Stumbling, shambling movement;
  • Judgement affected, becoming confused;
  • Drowsy;
  • Difficulty getting back on feet after rest;
  • Shivering when on move, becoming uncontrollable;
  • Disregard for cold (Jacket open gloves off );
  • Vision impaired.


  • Shivering stops (body unable to produce heat);
  • Slow jerky puppetlike movements;
  • Falling down;
  • Collapse;
  • Lapsing in and out of consciousness;
  • Hallucinations;
  • Slow breathing and pulse.

These notes are for guidance only.
Hillwalkers and climbers are strongly advised to attend a (Mountain) First Aid Course.
© Ian Roy, 1992.