Act on the signs immediately: tell the supervisor, request medical help, and call 911 when the worker is confused, unresponsive, breathing slowly, has a very slow pulse, has stopped shivering, or shows another emergency sign. Keep someone with the worker, move them gently to a warm shelter or vehicle, remove wet clothing, dry and insulate them, and monitor breathing and responsiveness.
This is first aid while professional help is coming, not a diagnosis or a substitute for medical care. Do not wait for a thermometer reading, unconsciousness, or complete loss of shivering before escalating. Hypothermia can impair judgment, so a worker may not recognize the danger or be able to ask for help. A coworker who notices clumsiness, unusual behavior, or confusion should intervene rather than assume the person is simply tired.
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Immediate response: what coworkers should do
Use this sequence for suspected hypothermia. One person should coordinate the response while another stays with the worker and watches breathing and responsiveness. Tell the supervisor what happened, where the worker is located, whether there was rain, sweat, or immersion, and whether the person has other injuries.
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- Alert the supervisor and request medical assistance. Call 911 immediately for an emergency. Emergency warning signs include confusion, slurred speech, worsening loss of coordination, inability to stand or walk, stopped shivering, slowed breathing or pulse, blue-looking skin, unresponsiveness, or any rapid deterioration. Do not delay the call to take a temperature or see whether warming alone works. The American Red Cross defines hypothermia as a core temperature below 95°F (35°C), but a measurement is not required before you act. If you are unsure whether the situation is severe, describe the signs to the dispatcher and follow the dispatcher’s instructions.
- Move the worker to warmth without jolting or unnecessary movement. Use a warm room, enclosed site office, heated vehicle, or other sheltered location. Handle a severely cold worker gently and keep them horizontal when practical; NIOSH advises this because a cold heart can be vulnerable to dangerous rhythms when the person is disturbed. Ask for enough people to assist with a safe transfer rather than making the worker walk. This handling precaution must not delay emergency services.
- Remove wet clothing and dry the worker. Cut away clothing that cannot be removed easily if necessary, replace it with dry clothing, and wrap the worker in loose, dry blankets, coats, towels, or other insulation. Cover the head and neck while leaving the face uncovered so breathing can be observed. If boots, gloves, or outer layers are soaked, replace them with dry items; do not leave damp fabric trapped against the skin.
- Warm gradually. Prioritize the chest, neck, head, and groin with dry insulation. Warm blankets, skin-to-skin warming under dry layers, or warm bottles and chemical packs can be used when they are available and safe. Put every warm bottle or hot pack inside a dry cloth barrier and check the skin frequently. Follow the dispatcher’s instructions. Do not use rapid or forceful rewarming, rub the worker’s skin, or place unprotected heat directly against the body; rapid rewarming and burns can trigger dangerous heart problems.
- Offer a drink only when swallowing is clearly safe. If the worker is fully alert and can swallow normally, offer a warm, non-alcoholic drink. Never give food or liquid to an unconscious, confused, vomiting, or poorly responsive person. Do not pressure a drowsy worker to drink.
- Check breathing and responsiveness continuously. If there is no pulse or normal breathing, activate emergency response and provide CPR and AED care within your training and the dispatcher’s directions. Do not leave the worker alone while another person retrieves supplies. If the worker becomes less responsive, tell the dispatcher immediately.
Keep the worker insulated and observed until EMS takes over. A person who appears better after warming still needs prompt professional assessment when hypothermia was suspected. Improvement in speech or shivering does not prove that the underlying problem has resolved.
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Recognize the progression of hypothermia
Hypothermia affects thinking and movement as well as body temperature. A worker may make unsafe decisions, deny that anything is wrong, or be unable to reach shelter. NIOSH lists the following progression in its Cold-related Illnesses in Workers guidance, dated March 3, 2026.
| Stage to recognize | Possible signs | What the crew should do |
|---|---|---|
| Early warning | Shivering, fatigue, poor coordination, clumsiness, confusion, disorientation, or unusual behavior | Stop cold exposure, alert the supervisor, request medical help, move the worker to warmth, and begin drying and insulating. |
| Worsening or late danger | Shivering stops, skin may look blue, pupils may dilate, pulse and breathing slow, the worker may be unable to stand or walk, or consciousness may be lost | Call 911, keep the worker horizontal and gently handled, monitor breathing and responsiveness, and prepare for CPR/AED if normal breathing or a pulse is absent. |
Stopping shivering is not recovery. It can indicate that the condition is worsening. A coworker should not attempt to grade severity from a skin, ear, or workplace thermometer reading; act on behavior, coordination, breathing, and responsiveness. A normal-looking reading can be misleading if the device is not designed for core temperature or if the worker has already been warmed.
Early symptoms can be easy to dismiss on a busy site. Shivering may be attributed to an ordinary cold morning, and a dropped tool or stumble may be blamed on fatigue. Treat a cluster of changes—such as shivering plus poor coordination, or confusion after getting wet—as a reason to stop the task and intervene. The affected worker may not be able to make a safe decision about continuing.
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Cold injury is not limited to freezing weather. OSHA’s Cold Stress Guide notes that hypothermia can occur above 40°F when rain, sweat, or other wetness chills a person. Wind, damp gloves and boots, inadequate breaks, exhaustion, and a worker’s inability to change out of wet clothing can accelerate heat loss.
Water exposure is especially dangerous. NIOSH states that hypothermia can occur in water below 70°F and that cold-water immersion develops more quickly than standard cold exposure. Treat a worker recovered from cold water as an urgent medical case even if they are still talking or shivering. Do not send an untrained person into the water to make a rescue; an additional victim can create a larger emergency.
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Hypothermia is dangerous partly because the worker may not know it is happening or be able to do anything about it. Use a buddy system rather than relying on a chilled person to self-report symptoms. Supervisors should watch for changes in speech, balance, pace, and judgment, not just complaints about feeling cold.
Safe warming: what helps and what can harm
- Use dry insulation first: loose dry clothing, blankets, towels, and a head covering reduce further heat loss. Keep the face clear.
- Warm the core gradually: focus on the chest, neck, head, and groin. A warm bottle or chemical hot pack must be wrapped in dry cloth and checked often to prevent burns. Place heat where it warms the trunk rather than pressing it against numb hands or feet.
- Keep handling gentle: avoid unnecessary walking, shaking, massage, or rubbing. Minimize transfers and keep a severely cold person horizontal when practical.
- Do not use alcohol: it is not a treatment and should not be offered as a way to warm the worker.
- Do not apply unprotected or intense heat: never put a heating pad, hot-water bottle, heat lamp, radiator, stove, fireplace, or other hot surface directly on skin. Do not attempt rapid rewarming or a procedure that could burn the worker.
- Use fluids carefully: warm, non-alcoholic drinks are only for an alert worker who can swallow normally.
Emergency dispatchers may change the immediate priorities based on the worker’s condition, location, immersion history, or other injuries. Keep the phone on speaker when possible and follow their directions. If the worker has fallen, been struck, or may have another injury, avoid moving them more than needed for immediate safety and follow dispatcher guidance.
If the worker fell into cold water
Do not send an untrained coworker into unsafe water. Activate the site’s emergency rescue procedure, call 911, and use approved rescue equipment or a trained water-rescue team. Once the worker is in a safe location, minimize movement, remove wet clothing, dry and insulate them, and monitor breathing. Because immersion can produce rapid heat loss, do not wait for severe symptoms before requesting medical help. Tell responders the approximate water temperature if known, how long the worker was immersed, and whether the person struck anything or inhaled water.
When frostbite is also present
Frostbite can occur alongside hypothermia, but it needs separate care. Do not rub, massage, or apply heating pads, heat lamps, stoves, fireplaces, or radiators to frostbitten tissue. Keep the area protected and dry while EMS provides direction. Whole-body warming instructions do not authorize direct heat on numb fingers, toes, ears, nose, or other frozen tissue. Tell the dispatcher about color changes, numbness, blisters, or severe pain so the worker receives appropriate evaluation.
Monitoring until EMS arrives
- Keep one person assigned to observe responsiveness and breathing continuously. Rotate observers if the wait is prolonged, but make the handoff explicit.
- Note when symptoms began, how long the worker was wet or immersed, the approximate environmental conditions, and any change in consciousness. Give this information to the dispatcher and EMS.
- Do not let the worker walk back into the cold, operate equipment, drive, or return to a cold task while recovering.
- If breathing becomes abnormal or stops, begin CPR and use an AED according to training and dispatcher instructions.
- Keep insulation in place and avoid repeated movement or exposure while waiting.
- Keep access routes clear so responders can reach the warm shelter or vehicle quickly. Assign someone to meet EMS at the site entrance if the location is difficult to find.
The reviewed workplace guidance supports warming, drying, and medical evaluation but does not establish a universal return-to-work clearance rule. A supervisor should arrange professional follow-up and keep the worker out of further cold exposure during recovery. Do not let a worker decide to “tough it out” because symptoms temporarily lessen.
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Prepare the workplace before cold stress occurs
Emergency response is faster when supplies, training, and a warm destination are decided before a shift begins. NIOSH recommends that employers and supervisors:
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- Provide access to warm spaces and a place where wet clothing can be removed and replaced with dry clothing. Keep the route to that space usable during the shift.
- Schedule warm-up breaks and adjust work practices when wind, rain, sweat, or cold water increases risk.
- Use a buddy or monitoring system so a worker’s confusion or clumsiness is noticed early, including for isolated or night work.
- Keep suitable cold-weather gear available and inspect gloves, footwear, and outer layers for wetness or failure. Plan dry replacements rather than expecting workers to continue in soaked clothing.
- Include a medical thermometer, an environmental thermometer, and chemical hot packs in first-aid supplies. Hot packs support careful warming; they do not replace 911, EMS, or clinical treatment. Store them where workers can reach them without entering the cold area again.
- Make sure workers know who calls 911, where the warm shelter is, how to reach the site entrance, and where the AED and first-aid kit are kept.
- Review water-rescue arrangements for work near ponds, tanks, rivers, or other cold water. Rescue equipment and trained responders are safer than improvised entry.
NIOSH’s workplace recommendations are detailed in Workplace Solutions: Preventing Cold-related Illness, Injury, and Death among Workers. OSHA’s signs and first-aid overview is available in its Cold Stress Guide.
Independent reader supportYour contribution helps us test, update, and keep practical guides available for everyone.Frequently asked questions
What do I do if a coworker is showing signs of hypothermia?
Stop the cold exposure, alert the supervisor, request medical help, and call 911 for emergency signs. Move the worker gently to warmth, remove wet clothing, dry and insulate them, and monitor breathing and responsiveness.
How do you treat hypothermia at work?
Workplace first aid is supportive care while EMS is coming: gradual protected warming, dry layers and blankets, careful monitoring, and CPR/AED care if normal breathing or a pulse is absent. It is not a substitute for professional assessment.
When should I call 911 for hypothermia?
Call immediately for confusion, slurred speech, inability to stand or walk, stopped shivering, blue-looking skin, slowed breathing or pulse, unresponsiveness, rapid deterioration, or any concern that the worker is in danger. Do not wait for a temperature reading.
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Can hypothermia happen when the air is above 40°F?
Yes. OSHA says rain, sweat, or other wetness can chill a person enough to cause hypothermia in cool conditions above 40°F. Wind and wet clothing can increase heat loss.
Should I give a hypothermic worker coffee or alcohol?
Give only a warm, non-alcoholic drink, and only when the worker is fully alert and can swallow normally. Never give liquids to someone unconscious, confused, vomiting, or poorly responsive, and do not use alcohol as a warming treatment.
Is stopping shivering a good sign?
No. Stopping shivering can be a late danger sign, especially when paired with slowed breathing, confusion, blue-looking skin, or loss of consciousness. Call 911 and continue monitoring.
The essential rule
Suspected hypothermia is an emergency risk, not a condition to watch casually. Shivering, fatigue, clumsiness, confusion, or disorientation are enough to stop the task, get the worker warm and dry, alert supervision, and request medical help. Call 911 for emergency signs, use only gradual protected warming, and keep monitoring until trained medical responders take over.
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Frequently Asked Questions
What do I do if a coworker is showing signs of hypothermia?
Stop cold exposure, alert the supervisor, request medical help, and call 911 for emergency signs. Move the worker gently to warmth, remove wet clothing, dry and insulate them, and monitor breathing and responsiveness.
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When should I call 911 for hypothermia?
Call immediately for confusion, inability to stand or walk, stopped shivering, slowed breathing or pulse, blue-looking skin, unresponsiveness, rapid deterioration, or any other emergency concern. Do not wait for a thermometer reading.
Can hypothermia happen above 40°F?
Yes. Rain, sweat, wind, or other wetness can chill a person enough to cause hypothermia in cool conditions above 40°F.
Should I give a worker a drink?
Only offer a warm, non-alcoholic drink to someone fully alert who can swallow normally. Never give liquids to an unconscious, confused, vomiting, or poorly responsive person.
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No. Stopping shivering can indicate worsening hypothermia. Call 911 and continue gentle warming and monitoring.
The Bottom Line
Bottom line: Treat shivering, clumsiness, confusion, or disorientation as warning signs. Alert supervision, call 911 when danger signs appear, move the worker to warmth, remove wet clothing, insulate and warm gradually, and monitor continuously until EMS takes over.
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