How to Recognize, Prevent, and Survive Cold Injuries in the Wild
“Cold doesn’t kill. Complacency does.” – Old mountaineering proverb
After 20+ years in extreme environments – from whiteout bivvies at 6,000 meters to jungle survival in freezing rain – I’ve learned one thing: the cold is an unforgiving teacher. It rarely shouts. It whispers – until it stops your heart.
This guide is designed to prepare you – both physically and mentally – to recognize, prevent, and respond in the fieldto hypothermia and frostbite, two of the most lethal and underestimated threats in mountaineering, especially at altitude or during alpine storms.
🧭 Table of Contents
- The Science of Cold Injuries
- What is Hypothermia?
- What is Frostbite?
- High-Risk Scenarios in the Mountains
- Prevention Strategies in the Field
- Recognizing Early Symptoms
- Field Treatment: Hypothermia
- Field Treatment: Frostbite
- When to Evacuate
- Final Words from Experience
❄️ 1. The Science of Cold Injuries
Cold weather doesn’t just make you uncomfortable – it can shut down your body’s core systems or destroy tissue permanently.
- Hypothermia = Systemic failure due to falling core temperature.
- Frostbite = Localized freezing of skin and tissues (usually fingers, toes, nose, ears).
Both can escalate rapidly in wet, windy, or high-altitude environments.
Important: Cold injuries often happen in above-freezing temperatures when wet + wind are involved.
🥶 2. What is Hypothermia?
A drop in core body temperature below 35°C (95°F). It’s not always dramatic – often slow, silent, and deadly.
⚠️ Stages of Hypothermia:
| Stage | Core Temp | Symptoms |
|---|---|---|
| Mild | 35–32°C | Shivering, confusion, fatigue |
| Moderate | 32–28°C | Violent shivering, slurred speech, coordination loss |
| Severe | <28°C | No shivering, unconsciousness, rigid muscles, possible death |
Field Tip: Shivering stops when hypothermia becomes severe. That’s not a good sign – it means your body gave up.
🧊 3. What is Frostbite?
Frostbite is freezing of the skin and tissues, causing ice crystals to form inside cells – often leading to permanent damage or amputation if untreated.
Common Areas Affected:
- Fingers & toes
- Nose & ears
- Cheeks
- Genitals (yes, it happens – protect everything)
Degrees of Frostbite:
| Degree | Symptoms |
|---|---|
| 1st | Numbness, pale or red skin, no blisters (frostnip) |
| 2nd | Blisters, swelling, waxy skin |
| 3rd | Blue-grey skin, blood-filled blisters, deep damage |
| 4th | Black, necrotic tissue, loss of digits or limbs |
🌨️ 4. High-Risk Scenarios in the Mountains
⚠️ Watch out for:
- Alpine starts (2–4 a.m.) in wet snow
- Wind chill below -10°C, even if ambient temp is higher
- Altitude camps above 4,000m
- Sweaty climbs followed by sudden stops (resting = cooling)
- Crevasse falls, wet crossings, unexpected bivouacs
Real World Case: On Aconcagua, I watched a fit climber go from shivering to unconscious in 90 minutes after a windy summit push with soaked gloves.
🛡️ 5. Prevention Strategies in the Field
🧥 Clothing:
- Layer like a system: Base (moisture-wicking), mid (insulating), outer (wind/waterproof)
- Keep extremities covered – especially hands and feet
- Carry extra dry socks, gloves, and base layer
- Never sleep in damp clothes
🔥 Behavior:
- Eat & hydrate often – cold burns calories fast
- Keep moving – inactivity accelerates cooling
- Know your team’s tolerance levels – watch them for signs
- Use hand warmers, Nalgene bottles with hot water, body contact when needed
🎒 Gear Essentials:
- Emergency bivy sack / sleeping bag
- Windproof outerwear
- High-calorie food
- Lighters/matches (in multiple locations)
Checklist: Always ask before summit push: “If we bivy tonight in a storm, can we survive it?”
👀 6. Recognizing Early Symptoms
Self-awareness saves lives. Cold confusion often prevents victims from realizing they’re in danger.
🚨 Hypothermia Signs:
- Uncontrollable shivering
- Slurred speech
- Clumsiness (tripping, dropping gear)
- Sudden apathy or withdrawal
- Confused decision-making (e.g. removing clothes)
🚨 Frostbite Signs:
- Numbness, then burning
- Pale, waxy skin
- No feeling in fingers or toes
- Skin stays cold even after warming attempt
- Blisters forming hours later
Buddy Rule: Always check each other’s cheeks, nose, fingers – even if they say they’re “fine.”
🩹 7. Field Treatment: Hypothermia
✅ DO:
- Shelter from wind immediately
- Remove wet clothes, wrap in dry insulation
- Provide warmth: hot drinks, body heat, heat packs
- Rewarm slowly: especially torso first
- Stay with patient – monitor breathing and consciousness
❌ DON’T:
- Give alcohol or caffeine
- Apply direct heat (can cause arrhythmia)
- Leave them alone
- Assume they’re dead if unresponsive (rewarm first)
Critical Note: A hypothermic person may appear dead. Many have recovered from severe hypothermia with core temp as low as 20°C.
🧤 8. Field Treatment: Frostbite
✅ DO:
- Move victim to shelter immediately
- Remove wet gloves/socks and insulate
- If no risk of refreezing, rewarm in warm (NOT hot) water ~38–40°C for 20–40 minutes
- Give ibuprofen to reduce swelling
- Wrap loosely in sterile dressings
- Elevate affected limb
❌ DON’T:
- Rub or massage the area (causes more tissue damage)
- Use dry heat sources (e.g. fire, stoves)
- Rewarm if the area might refreeze
- Pop blisters
- Walk on frostbitten feet unless evacuating
Field Wisdom: “Thaw and go” is a last resort. If you rewarm in the field, be 100% sure you can keep it warm – or you’ll make things worse.
🚁 9. When to Evacuate
Evacuate urgently if:
- Core temperature <32°C and worsening
- No shivering + loss of consciousness
- Third or fourth-degree frostbite suspected
- Confusion, disorientation, or irrational behavior
- Victim is unable to move independently
Evac Pro Tip: Mark frostbitten areas clearly before evac. Swelling makes them hard to locate later.
🏔️ 10. Final Words from Experience
In cold terrain, prevention is your best survival tool. Once hypothermia or frostbite sets in, the margin for error narrows fast.
I’ve lost feeling in fingertips for weeks. I’ve seen climbers lose toes. I’ve helped evac unconscious team members through sleet and wind. And I’ve also seen 100% recovery when swift, calm field treatment was applied.
Train cold. Think cold. Stay aware.
And always ask: “What if I have to survive the night right here?”
Stay warm. Stay alive.
— J.L., Climber, Survival Instructor & Cold Weather Specialist
