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An enemy lurks in the coldest depths of the land, taking thousands of victims. But it’s not wildlife. It’s the cold itself. Recognizing hypothermia symptoms can keep you from becoming another victim.

Over 1,300 people die each year due to cold exposure. Twice as many men die as women. Victims range from hunters caught in the snow to elderly citizens living alone and symptoms can mimic those of common health conditions. Exacerbating hypothermia are diabetes, medical conditions, some medications, trauma, or drugs and alcohol. Even infants sleeping in cold bedrooms can be at risk.

Prevention

If you avoid hypothermia symptoms, you don’t have to treat them.

Dress Warmly: This is often overlooked. A vehicle can break down in the middle of January when a short trip was intended. Young adults go camping in the late autumn, overlooking the possibility of a sudden storm or a cold night.

Choose the Right Fabrics: There’s a reason wool socks are in demand at sporting goods stores. The scratchy fabrics stay warm even when wet. Most fabrics wick heat away from the body when they get wet or sweaty, such as cotton jeans and t-shirts. Choose clothing which repels snow, rain, and wind. They keep water from invading your clothing shell and avoid the wind chill factor, which can make a temperature of 20 feel like -20.

Wear Layers: Layers come off when you get too warm and go back on when you’re cold again. Wear soft nylon stockings beneath wool socks to avoid blisters. Layer a thermal undershirt with a flannel top, then cover with a jacket or sweatshirt and a warm winter coat. Remove the coat before you start to sweat.

Protect Your Core: Frostbite rarely kills. So think about your core before your fingers and toes. Protect the heart and liver because that’s where heat is generated and where it retreats when your body is in shock. Experienced river rafters choose insulating life jackets because they know cold water plus exhaustion can kill even in the summer.

Stay Dry: Avoid the water when it’s really cold. If it rains, find shelter. And if your clothes get wet, change out of them as soon as possible.

Plan Ahead: Even tough Spartan sporting events recognize hypothermia symptoms and offer shiny silver blankets at the finish line. What is in your vehicle to insulate you if you break down? What in your house can warm you up if electricity goes out? Do you carry granola bars in your backpack? Do you know how to make candles, matches and fire starters? Or do you have a small box containing matches and fire starters, high-calorie food, and emergency blankets can save your day? Research first aid kit content lists, and their uses, then keep one kit in your vehicle and another in your house. Add a personal touch by learning how to make candles for cooking and emergency lighting.

Eat Right: The metabolic process needs fuel. High-calorie foods produce heat while protein sustains it and fat feeds the brain and nerves. Fruit-and-nut bars don’t spoil fast, are portable, and provide necessary macronutrients. Drink plenty of water to keep your metabolism working correctly and help control neurologic processes such as brain function and muscle response.

Don’t Over-Exert: Physical exertion warms you. Too much could land you in hot water. If you expend all your energy on recreation or work then can’t find shelter soon enough, you’ll have little left to maintain your body temperature. Hypothermia symptoms may mimic exhaustion, such as shivering, weakness, clumsiness, and irrational behavior.

The Buddy System: Even early hypothermia symptoms can be devastating because, by that time, the victim may not realize she is in danger or have the mindset to get to safety. During outdoor activities in cold weather, bring someone who can recognize hypothermia symptoms and know how to safely warm you up.

Avoid Alcohol and Caffeine: A shot of brandy feels warming because it dilates blood vessels, bringing heat to the skin. Keep the heat where it belongs when there’s danger of exposure. Caffeine quickens the pulse, which also dilates superficial vessels.

Recognition

How long does it take to get hypothermia? It depends on your environment. The body, which is normally 98.6 degrees, can drop below 96 within ten minutes when trapped in a cold lake because water conducts heat away from the body 25 times faster than air does. People with more body fat are better insulated. Even an 80-degree lake can be dangerous if a swimmer doesn’t leave the water before his body temperature drops.

Mild hypothermia is a body temperature of 89-95 degrees. Moderate is 82-89, and severe falls below 82. But because each body responds differently to cold and shock, temperatures may vary.

Cold Shock Response: Someone who drops into cold water immediately hyperventilates. For a few minutes they gasp and struggle, and can be in danger of drowning, but the response soon ends. This is not hypothermia but it’s an indication that matters can go downhill fast.

Shivering: This early symptom can happen before the body becomes hypothermic. Shivering as an involuntary response produces body heat. If you start to shiver, get out of the elements and warm up.

Apathy and Poor Judgment: Many victims succumb because brain activity slows down and nobody is around to notice. Poor judgment keeps you from seeking shelter and you may not want to take care of yourself.

Slurred Speech, Confusion, Loss of Coordination. These hypothermia symptoms can also indicate diabetic shock, exhaustion, or mental illness. Many impoverished or homeless people die each year, though symptoms would be evident to someone who recognizes them.

Gray Skin, Numbness, Clumsiness: Blood and body heat recede inward to protect the heart and other internal organs. Blood vessels constrict. Muscles cannot perform tasks. This starts as simply as difficulty tying shoelaces and extends to stumbling and falling.

Loss of Strength, Sleepiness: As the body struggles to survive, extremities stop working so the core can. The body wants to rest and recover.

Slow Pulse, Shallow Breathing: The late symptoms of hypothermia indicate that the victim needs immediate treatment because the body is shutting down.

The Core is Cold to the Touch: If the area around the heart and liver is frigid, body temperature may have dropped below 90 degrees. Shivering may also stop at this temperature.

Treatment

Consider treatment when you write your survival gear list. Include hand warmers, emergency blankets, matches, and fire starters. It’s easier to treat hypothermia if you’re prepared.

Find Shelter: Bring a cold person into a warm building. If you’re away from civilization, find a place away from wind and moisture. Even thick blankets retain heat and keep away the elements.

Remove Wet Clothing: This includes wet hats and gloves. They will steal warmth away rather than insulate.

Offer Warm Liquids: Avoid alcohol and caffeine, because both speed up heat loss. If you can, provide a drink that also supplies nourishment, such as hot cocoa or soup. Never give food or drink to an unconscious person.

Medical Attention: If you notice symptoms have gone past a chill, find medical treatment. Ambulances have warming blankets. Ski patrols even carry first aid supplies.

In Survival Situations

Heat from the Inside Out: Water heated over a campfire warms the body’s core, as long as it’s not hot enough to damage tissues.

Keep Limbs in Tight: If you cannot find shelter, curl into a fetal position. Hold your arms against your chest if you’re trapped in water.

Get Dry: Get into dry clothes as soon as possible. If you only have a blanket, remove wet clothing and attempt to dry them over a fire as you wrap yourself.

Avoid Overheating or Friction: Rubbing your hands or immersing them in hot water can do more harm than good. Warm them slowly.

Warm with Body Heat: Just as frozen fingers warm best on a friend’s cold neck, a hypothermic body warms best in contact with other skin. If you must warm someone, remove their clothing and yours. Add a third person if possible. Make a naked body sandwich, wrapped in a blanket.

Whether you’re working in the countryside or surviving in the city, recognizing hypothermia symptoms and knowing how to treat them saves lives that can be stolen away fast.