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All of the arguments I've heard against using this method assume that you have adequate supplies for alternate rewarming methods. If you literally didn't, and it appeared they were going to freeze to death anyway, would you have a whole lot to lose? Of course, if you felt yourself starting to get hypothermic as well, then I'd guess you should stop and reassess the situation, but should you at least try this method first?

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What stage of hypothermia? The answer would differ between 1st stage vs severe hypothermia. –  manoftheson Mar 10 '13 at 7:00
I suppose if the alternative is the person will die, then there is little downside. However, it could actually make things worse for severe hypothermia. At that level, the body needs to be warmed from the inside out. If not, the toxins that have built up in the extremities can get you. This needs to be done in a medical setting. If someone is still concious, get some hot liquid in them, otherwise evacuate if possible. –  Olin Lathrop Mar 10 '13 at 16:08
Conscious, but reduced shivering and beginning to act irrationally - I guess severe hypothermia? –  Chris Carr Mar 11 '13 at 1:38
@OlinLathrop - My training taught not to give any food or liquids to a severely hypothermic person as it can cause other problems, like a blocked airway. But giving food and liquid to a person with mild to moderate hypothermia was recommended to help supply the calories for them to generate heat on their own. –  manoftheson Mar 11 '13 at 7:34
@ChrisCarr - By the way, welcome to The Great Outdoors SE! –  manoftheson Mar 11 '13 at 21:02
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1 Answer

First, this answer is not a substitute for proper training. I recommend taking a class in Wilderness First Aid or higher to be better prepared for things like treating hypothermic people.

Second, hypothermia is a term that tends to have different connotations with different people. Sometimes what people call "hypothermia" is just a very cold individual, or they mean someone who is shivering uncontrollably for example. The stages of hypothermia are really a sliding scale with the varying degrees of severity sort of fading into each other. But regardless, treatment for 1st stage hypothermia is very different from severe hypothermia at the other end, especially in a backcountry scenario with limited or no resources.

For this question, a moderately severe hypothermic person seems to be the patient being referenced. Typical signs & symptoms would likely include:

  • Shivering has now ceased after previously shivering uncontrollably

  • If responsive, will likely claim to feel warm again despite their body temperature being dangerously low

  • Level of responsiveness is declining, entering into a stupor. Eventually becoming unresponsive or unconscious.

  • Not aware of much, if at all

  • Skin is pale and cold. Lips are blue/purple

  • Heart rate and respiratory rate are slowing to the point of being hard to detect

  • No longer able to warm themselves from their own metabolic processes

  • Needs immediate evacuation to medical care.

With this particular patient example, warming them in the field is not a realistic prospect. You need to seek help for them, and get them out of there ASAP. Body-to-body warming, if anything, is only going to help stabilize them and keep them from getting even colder. But even then it's not a very effective way to try to warm someone in a hypothermic state, especially one of any significant degree.

But in short, body-to-body contact could be used to treat this patient as a last resort, but only as a last-ditch effort to help stabilize them until help arrives, assuming help is on the way to your location and also assuming you have no other heat sources (fire, stove...). If no help is available then trying this treatment is probably better than nothing at all. Just be careful and don't make yourself in to a patient as well!

Side note: Don't let the person get this bad! Any treatment methods including the one being discussed here (which is not the standard of care) are going to be more effective the earlier you catch the hypothermia. Time is not your friend here, so act quickly.

This article from NOLS provides some relevant information to this treatment method:

According to Gordon Giesbrecht an adult cooled to 95°(34.7C), the common threshold for hypothermia definitions, can have a profound caloric deficit. ² A healthy adult at rest will make about 1 kcal of heat per kg of body weight per hour. This won’t be enough to quickly reverse significant hypothermia. In those tales where we got in a sleeping bag and heroically warmed the severely cold person – well - we may have done the patient a favor, but they probably were not very cold in the first place.


According to Dr Giesbrecht ³, the transfer of the energy to the core will be blunted by vasoconstriction. Since most of our mildly hypothermic patients are not dramatically vasoconstricted, this will be only a small hindrance. In severely hypothermic patients it may be a significant limitation to the heat transfer from donor to recipient.


People who are truly hypothermic are dangerously ill. They may be wasted (a non-medical term that says they are fatigued, dehydrated and low on food reserves), or have a serious simultaneous medical condition. We may not be able to warm these people in the backcountry. Our efforts are focused on stabilizing the patient; we don’t want to jostle them or allow them to cool further. They likely will only warm in the hospital, so we transport them gently.


I’ve been told two people in a sleeping bag to treat hypothermia is the “standard of care” in the wilderness. Actually, it’s not. The science isn’t strongly in it’s favor and in the wilderness, scenarios are often unique, our equipment less than ideal and our need to improvise real. As always, we’ll use our judgment, understand the principles of treatment and weight the factors in our specific scenario. The heat sources you have available on your wilderness trip may only be insulated hot water bottles, or the patient’s metabolism and shivering. If you have a good camp and plenty of people you may be able to spare a person to be in the sleeping bag. If you’re a small group, and knowing heat transfer between bodies is not very efficient, you may decide your assistant is best used staring a fire, making a warm meal and drink on the stove, setting up the camp or attending to the other people on your trip.


2. Giesbrecht GG, Sessler DI, Mekjavic IB, Schroeder M, Bristow GK. Treatment of mild immersion hypothermia by direct body-to-body contact. J Appl Physiol. 1994;76: 2373–2379

3. Hypothermia, Frostbite and other Cold Injuries. 2ed Giesbrecht GG and Wilkerson JA. The Mountaineers. 2007.

Sources: Wilderness First Aid from NOLS WMI, other training, and years of experience.

The article referenced above from NOLS.

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Thank you for the info. It is very useful to know. Just a couple other questions - I understand based on what you said that it’s highly unlikely it would ever come down to this, but if body-to-body stabilization seems the only option, should it be skin-to-skin, or can thin layers of clothing be left on? Also, as Olin Lathrop said, there is danger of toxins from the extremities causing damage, so if you’re forced to use this method, should care be taken not to come into contact with the hypothermic person’s extremities? –  Chris Carr Mar 11 '13 at 21:02
According to that article from NOLS I referenced, skin-to-skin contact is the only way to get any real chance of heat transferred to the patient. Care should certainly be taken, but you'd want to achieve as much surface area contact as possible. Are you asking about the possibility of toxins harming you or the patient? –  manoftheson Mar 11 '13 at 21:07
Well I was unclear myself whether he meant the rescuer or the rescuee, but in any case I've heard that if heat is applied to the skin of a hypothermic person, there's danger of cold blood from the extremities being pumped back to their heart. Is this correct, and if so, should contact with their extremities by avoided? –  Chris Carr Mar 11 '13 at 22:09
Well I think part of the point of the article is that the severely hypothermic person is so vasoconstricted that this probably wouldn't happen just from the skin-to-skin heat transfer, because it's just not enough heat to really warm them up. This is a valid concern though, and I'm not sure about the extremities. Normal treatment methods call for hot water bottles under armpits and at the groin to heat directly near the main blood supply, so it seems that would also cause blood to pump back from the extremities. Anyone else care to weigh in on this? –  manoftheson Mar 12 '13 at 1:00
@Chris: What I was referring to is when hypothermia has progressed so far that the body shuts down blood to the extremities in the last effort to keep the core alive. Toxins then build up in the extremities. The victim can be poisened by his own toxins if the extremeties are warmed first. The person needs to be warmed from the inside out in a medical setting. Keep in mind we're talking about sever hypothermia progressing immenently to death without medical intervention. If someone can drink warm liquid, by all means have them do it, preferably containing fast-metabolizable sugars. –  Olin Lathrop Mar 12 '13 at 19:58
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