No one is dead until they are warm and dead. Aggressive resuscitation until core temp normalized.
Steps by Cert Level
ALL: Remove wet clothing. Passive rewarming: blankets, warm environment. Handle gently — severe hypothermia patients are prone to VF with rough handling.
EMT: Mild (90–95°F): shivering present — passive warming. Moderate (82–90°F): no shivering — active external warming (heating pads to axilla/groin — NOT skin).
AEMT: IV warm NS 40–42°C if available. Glucose check — hypoglycemia common in hypothermia.
PARAMEDIC: Severe (< 82°F): cardiac monitor mandatory — VF risk is extreme. Withhold medications until temp > 86°F. Standard ACLS at < 30°C. 1–2 defib attempts only until rewarmed. Cardiac arrest: CPR + rapid transport to ECMO-capable facility.