Exposure
Cold air, wind, water, wet clothing, prolonged ground contact, and limited shelter can accelerate heat loss.
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Massachusetts EMS Environmental Course
Environmental Hypothermia
Adult and pediatric recognition, prevention of further heat loss, gentle handling, prolonged pulse assessment, rewarming support, cardiac-arrest considerations, and documentation.
Protocol
Massachusetts 2.8
Version
2026.2
Assessment
25 Questions • 80%
Section 01
Learning Objectives
By the end of this course, the learner should be able to:
Recognize environmental hypothermia in adult and pediatric patients.
Prevent additional heat loss and avoid harmful handling.
Assess pulse and respirations for a full 60 seconds when indicated.
Apply EMT, Advanced EMT, and Paramedic standing orders.
Identify when warmed oxygen, warmed IV fluids, and core-temperature monitoring are appropriate.
Apply hypothermia-specific cardiac-arrest and reassessment priorities.
Section 02
GrumpyMedic Protocol Reference
Review the Massachusetts hypothermia protocol before continuing.
Protocol Reminder
Verify the current Massachusetts statewide protocol, addenda, service policy, local Medical Control requirements, and your authorized scope of practice before clinical use.
Section 03
What Is Environmental Hypothermia?
Hypothermia occurs when heat loss exceeds heat production and core temperature falls.
Impaired Heat Production
Age, illness, intoxication, hypoglycemia, exhaustion, and altered mental status may reduce the patient’s ability to generate or conserve heat.
Physiologic Risk
As core temperature falls, the patient may develop impaired judgment, bradycardia, respiratory depression, dysrhythmias, and cardiac arrest.
Section 04
Prevent Further Heat Loss
Initial care focuses on gentle handling and environmental protection.
- ✓Avoid rough movement.
- ✓Insulate the patient from the ground.
- ✓Shield the patient from wind and water.
- ✓Move the patient to a warm environment as soon as practical.
- ✓Remove wet clothing.
- ✓Cover the patient with warm blankets, particularly the head.
Gentle Handling
Avoid rough movement. A profoundly hypothermic patient may be physiologically fragile and vulnerable to dysrhythmia.
Section 05
Initial Assessment
A slow pulse or respiratory rate can be difficult to detect.
- ✓Assess pulse and respiratory rate for 60 seconds when profound hypothermia is suspected.
- ✓Determine whether the patient is pulseless or in profound asystole.
- ✓Evaluate mental status and airway protective reflexes.
- ✓Check blood glucose when altered mental status is present.
- ✓Identify possible coexisting overdose or toxicologic causes.
- ✓Reassess temperature, perfusion, and respiratory status during transport.
Full 60-Second Assessment
Assess pulse and respiratory rate for a full 60 seconds when determining pulselessness or profound asystole.
Section 06
EMT Standing Orders
EMT care emphasizes protection, oxygenation, arrest care, and correction of reversible threats.
Routine Care
- ✓Provide routine patient care.
- ✓Prevent additional heat loss.
- ✓Move to a warm environment when practical.
- ✓Remove wet clothing and cover the head.
- ✓Reassess mental status, airway, breathing, and circulation.
Supportive Treatment
- ✓Provide oxygen when clinically indicated.
- ✓Use warmed, humidified oxygen when possible.
- ✓Manage hypoglycemia under the appropriate protocol.
- ✓Consider overdose or toxicologic causes.
- ✓Do not delay appropriate transport.
Section 07
Advanced EMT Standing Orders
Advanced EMT treatment includes warmed vascular volume support.
Warm IV Fluids
Warm IV fluids should be used when vascular access and fluid therapy are indicated. Continue frequent respiratory and perfusion reassessment.
Section 08
Paramedic Standing Orders
Paramedic care adds core-temperature measurement when available and tolerated.
Absent Pulse and Breathing
Treat under the appropriate cardiac-arrest protocols after confirming pulselessness with an appropriately prolonged assessment.
Core Temperature
When available and tolerated, insert an esophageal temperature probe and measure core temperature.
Section 09
Cardiac-Arrest Considerations
Hypothermic cardiac arrest requires disciplined confirmation and protocol-based treatment.
- ✓Initiate CPR when pulselessness is confirmed.
- ✓Administer oxygen using an appropriate delivery device.
- ✓Use the AED according to protocol guidance and advisories.
- ✓Manage cardiac arrest under the appropriate Massachusetts arrest protocol.
- ✓Use warmed, humidified oxygen when possible during resuscitation.
- ✓Handle the patient gently throughout movement and resuscitation.
Clinical Caution
Do not assume death based only on cold skin, slow breathing, or a difficult-to-detect pulse. Complete the prolonged assessment required by the protocol.
Section 10
Oxygen and Rewarming Support
Rewarming support should be controlled and focused on preventing further heat loss.
Warmed, Humidified Oxygen
When possible, use warmed, humidified oxygen at 104–107 °F (40–42 °C) by non-rebreather mask during resuscitation.
Warmed IV Fluids
Use warmed IV fluids for indicated vascular support. Continue monitoring perfusion, breathing, and response during transport.
Section 11
Critical Cautions
Avoid interventions that may increase aspiration risk or cause tissue injury.
Caution
Nothing by Mouth
Do not administer anything orally unless the patient has a reasonable level of consciousness and a normal gag reflex.
Caution
Do Not Massage Extremities
Do not massage the extremities in an attempt to actively rewarm the patient.
Section 12
Clinical Scenarios
Pause before opening each discussion.
Case: Cold-Water Exposure
An adult is removed from cold water, is confused, has wet clothing, and has a weak, slow pulse.
Discussion: Handle gently, remove wet clothing, insulate from the ground, cover with warm blankets, assess pulse and respirations carefully, provide oxygen as indicated, and transport.
Case: Possible Cardiac Arrest
A profoundly cold patient appears apneic and pulseless after prolonged outdoor exposure.
Discussion: Assess pulse and respirations for 60 seconds. If pulselessness is confirmed, begin CPR, provide oxygen, apply the AED, and follow the appropriate cardiac-arrest protocol.
Case: Altered Pediatric Patient
A child is cold, lethargic, and has an uncertain oral intake history.
Discussion: Protect from further heat loss, support airway and breathing, obtain glucose, avoid oral intake unless consciousness and gag reflex are adequate, and transport.
Case: Rewarming Error
A bystander begins vigorously rubbing the patient’s arms and legs.
Discussion: Stop the massage. Continue gentle handling, passive insulation, and protocol-directed central rewarming support.
Section 13
Documentation
The PCR should show exposure history, assessment, treatment, and response.
- ✓Environmental conditions and duration of exposure
- ✓Wet clothing, water exposure, wind, and ground contact
- ✓Mental status and airway protective reflexes
- ✓Pulse and respiratory assessment duration
- ✓Blood glucose when obtained
- ✓Oxygen device and whether oxygen was warmed/humidified
- ✓IV access and warmed fluid administration
- ✓Core temperature method and value when available
- ✓Cardiac rhythm, AED use, and resuscitation care
- ✓Rewarming interventions and patient response
Section 14
Key Takeaways
Review these points before the final quiz.
Handle hypothermic patients gently.
Prevent further heat loss immediately.
Assess pulse and respirations for 60 seconds when indicated.
Use warmed, humidified oxygen when possible.
Use warmed IV fluids when indicated.
Treat confirmed cardiac arrest under the appropriate protocol.
Do not give oral intake without adequate consciousness and gag reflex.
Do not massage the extremities.
Course Review Complete
Ready for the final assessment?
The quiz contains 25 questions. A score of 80% or higher unlocks the completion certificate.
Begin Quiz