Effects of prolonged mild hypothermia

[voidbeetles]

Hi! First post here, hope I'm doing it right :)

I have two characters who are sheltering in an abandoned building in below-freezing temperatures (exact temperature is kept vague). They have various supplies, such as blankets and tools to make a fire, but neither came prepared to deal with weather this cold. One of them, we can call them character A, is already dealing with the effects of accidentally falling into a frozen lake before they both finally found the building to take shelter in. For plot reasons, they're going to have to stay in this building for about three days before they can finally move to somewhere properly warm.

Character A is definitely going to be suffering from hypothermia, but a lot of what I've found describing the effects of hypothermia seems to fall into one of two categories: either, it describes what happens when you get it and then immediately get treatment, or it describes how you can die horribly (and quickly!) from it. Maybe I'm missing something, but I'm having trouble extrapolating what hypothermia looks like when you're able to treat it a little bit, but not well. Character A will receive some warming from the blankets and the fire, and while this will keep them from dying, I don't think they're going to be having a great time (ultimately they're still stuck in a cold environment!). I can guess at what symptoms they'll be experiencing (lots of shivering! sluggishness/tiredness/confusion! etc!) but if anyone has any more medically-informed guesses or suggestions, I'd love to hear them!

A few more details that are probably worth mentioning:
- The POV of this chapter is Character B, who'll be caring for Character A as best they can (and without much medical knowledge), so I'm more curious about what symptoms they'd notice rather than how A would experience them.
- Ideally, Character A is pretty incapacitated throughout this whole thing. I think they would be conscious, but I want them to be in bad enough shape that they won't be doing a lot of moving around or talking.
- Even after they've moved into a warmer climate, The Plot will necessitate both characters doing a lot of walking/running around. What lingering effects might Character A experience from their hypothermia bout?

Comments

[conuly]

exact temperature is kept vague

Sensible. Keep doing that!

[hamatebones]

Agreed. You can die of hypothermia if you're outside in just slightly-cool weather for too long. There are many, many stories of someone who walked home drunk, wandered into a field by accident, and was found dead the following morning. In October.

(It usually takes longer than 1 night if you're not drunk, but people get stupid and/or unlucky all the time. Fun fact: one of the common symptoms of advancing hypothermia is that you get stupid.)

[goddess47]

I am not a medical professional (but maybe that's best) but I would expect hand and feet problems... essentially 'frostbite' on both the hands and the feet that the person who fell into the ice cannot hold things and will have great difficulty walking. So you plan for walking/running after staying in the building will definitely be problematic... shuffling at best, would be my instincts.

You might be able to tone that down if they barely got wet (i.e. a big puddle rather than a lake) but if it was a good, soaking wet in icy water, even with quickly getting out of the wet clothes, walking/running will be hard.

You could slow Character A down by having them in a large puddle *and* they hit their head so that they have a concussion. That would slow them down for a bit but allow you to have them move better in your three days.

Good luck!

[voidbeetles]

Ooh, I was thinking that frostbite would be less of a concern (especially since they're not in the ice water for very long, just in and out, and they're able to get mostly-dry soon afterward) but I'll for sure look into it more. Especially what the recovery timeline for that would look like! Maybe they just get lucky and get a very mild case...

[hamatebones]

If they're in an environment where it's below freezing, they're susceptible to frostbite even when dry. That's why it's called frostbite: it's the water molecules inside your skin (and, later, in muscles) freezing solid, like dew freezing on a leaf. The big difference between the water molecules on a leaf and the ones in your skin is that your skin has blood flow constantly bringing new warmth out to it, so some of the heat lost to the environment gets replaced. Frostbite doesn't strike instantly the minute the thermometer drops below 32F. But eventually the body prioritizes keeping the brain and heart functioning (that's hypothermia at work) and effectively abandons the extremities to frostbite by rerouting warmth to stay in the body core.

Relatedly, I spent an hour standing still outside yesterday in 36F (doing a neighborhood event), and by the end I was miserable. It wasn't below freezing! It wasn't even windy! I had long johns and a puffy coat and a knitted hat and half-gloves and even pockets. My fingers HURT from the cold, and I was shivering constantly by the time I went inside. It wears you down, cold like that. It requires a lot of calories -- ideally hot calories -- to keep your body and brain moving in cold like that.

[yhlee]

I'm hoping someone medical weighs in; I could swear I saw a paper on exactly this in the New England Journal of Medicine sometime in the 1980s (my father, now retired, used to be a surgeon) but I'm having trouble tracking it down on JSTOR.

This one (different medical journal) might discuss the topic in a way relevant to your question - I have to run and can't look further, but perhaps someone else has a better lead:

Frostbite
Source: The British Medical Journal , Jan. 12, 1974, Vol. 1, No. 5897 (Jan. 12, 1974), pp.
67-70
Published by: BMJ
Stable URL: https://www.jstor.org/stable/25422470

[anne]

The thing about frostbite (and heatstroke) is that once you get them, your tolerance is reduced and you're more susceptible in the future. Your character will be dealing with this for the rest of time.

[full_metal_ox]

Silent movie actress Lillian Gish, the leading cinematic Damsel In Distress of her day, was committed to her art to the degree that she lay for hours with her hair and one arm trailing in near-freezing waters in the famous ice floe scene from Way Down East(1920); she incurred lifelong nerve damage and cold sensitivity in the afffected arm.

https://genxpose.blogspot.com/2018/08/down-frozen-river-of-death.html

[the_siobhan]

Yeah I got frostbite in my ears as a teen. I never regained proper circulation and they have been prone to frostbite ever since, even if I don't even feel the cold otherwise.

[voidbeetles]

Ah yeah, I remember that... sounds like a great way to introduce more stress later in the story!

[voidampersand]

I've had mild hypothermia from sleeping in a cold cabin with a crummy sleeping bag. In the morning I went out to enjoy the sunshine and the lovely icicles. Back inside, my vision went yellow and purple, then black, and I passed out. When I came to, I was wrapped in blankets and they made me cream tea.

If A fell in a lake, both A and B need to take their clothes off and get in the blankets together. This is standard first-aid practice. The only thing warm enough to keep A alive is B. I can't say this strongly enough. It is an emergency. Clothes off, now! Both into the blankets. Unless both A and B have no clue.

The fire is to help keep B warm, dry off A's clothes, and make hot water. Even if they don't have coffee, tea, or cocoa, make some hot water and get it in both of them. Hot food is good, but hot liquid is best. Making hot water takes a lot of time and fuel. It is a constant preoccupation. The most efficient way to burn wood is to make a tiny fireplace out of bricks or rocks. Make it tall, narrow, and not very deep. Have a couple handfuls of sticks burning in it and keep feeding it. Balance one or two pots on top. Hope you got pots. Mugs could do in a pinch.

[full_metal_ox]

Back inside, my vision went yellow and purple, then black, and I passed out.

Huh. I’ve had the same thing happen with heat exhaustion.

[mecurtin]

The only thing warm enough to keep A alive is B. I can't say this strongly enough. It is an emergency. Clothes off, now! Both into the blankets.

For best results, they should be face-to face, or rather abdomen-to-abdomen, that will transfer the most heat fastest. A's hands should be between them. A brick or stone can be *lightly* warmed in the fire, WRAPPED, and put at A's feet.

Put something warm&dry on A's head! this is no time to let the head stick out.

[voidampersand]

+1

[voidbeetles]

Sounds like an excellent opportunity for character bonding! This will be fun to add in, I think. I don't think either of them would know about this first aid procedure but I'm sure they could intuit something along those lines. (and yes, they do have pots with them! fortunate!)

[hamatebones]

I remember a Reddit thread asking about this very topic, "Is huddling for warmth sexy??" and the first-hand accounts made it extremely clear: no. It fucking sucks. Not in the fun way.

One guy in particular described how he was out hiking/camping with a male friend, they both got unexpectedly soaked on a chilly day, and stripped down to their underpants to huddle together inside conjoined sleeping bags inside a tent. They were shivering, and banged into each other! They were both clammy! They never got comfortable enough to sleep, and just had to lie there all night hoping things wouldn't get worse! All the unwanted intimacies of being forced to share space unexpectedly, and so physically miserable that it was just a matter of enduring till morning and they could pack up and leave. He mentioned that they both went straight to a doctor on returning to town.

[full_metal_ox]

I’d also recommend that A tuck their hands into B’s armpits (which could be additional fun if B has sideboob to speak of.)

[lilacsigil]

I've never suffered dangerous hypothermia, but I have been stuck in wet clothes in a chilly (well above freezing) environment for a long period of time, and "sluggish" is really the best term for it. You can't really think straight, you can't co-ordinate your body, you can't think more than a single step ahead. It was really hard to work out how to get up, pull my pants down, and go pee behind a tree, even though that's something I had done many, many times before. I wasn't at risk of frostbite (which is where the long-term consequences come in) but I could easily have injured myself and I did in fact partially melt the soles of my sneakers because I couldn't work out how close to the fire I could sit.

But A is in a much more serious condition than I was unless B knows enough first aid to warm them up properly.

[hamatebones]

If you're serious about first-hand experiences of lengthy hypothermia, your best resource might be climbing nonfiction. Sometimes climbers manage to rescue and revive someone who's fallen into the nexus of cold/exhausted/undernourished/dehydrated (eventually, they all become the same thing), but that's what generally kills people on mountains much more often than spectacular falls.

Ed Viesturs has written two different memoirs, and personally witnessed a ton of distressed high-altitude climbers. James Tabor's Forever on the Mountain, about 7 guys who died on Denali, goes into considerable detail about how people slowly die of cold, partly by being unable to replace the calories burned by shivering.

I had hypothermia and...

[(Anonymous)]

I got hypothermia while camping and the thing my friend noticed first was that my short term memory was rubbish; I kept trailing off mid-sentence and forgetting what I was talking about, or I would repeat the same thing every few minutes and forget I'd already said it. At first (and while still camping in the cold and wet) I felt really hot and tried to take off all my clothes which made the hypothermia worse; after a few hours of that, I felt freezing and shivered and didn't really move or speak. For the next few days, even after I was warmed up and in my house, I was very tired and would occasionally have to sit down because I would get very dizzy, and my heart would feel like it was beating very hard. I continued to have brain fog for a little while as well, but not as bad as the first day. After about five days in the warmth, I went back to normal.

Re: I had hypothermia and...

[full_metal_ox]

Yeep—glad to hear that you got back safe! Have you suffered any lingering effects?

[zinabug]

Hi! I've got more medically informed guesses/suggestions, I have EMS/first responder training and I know things about wilderness survival! I know I'm coming in with thoughts like a month after you posted this, hope it's still helpful. Asterisk that all of this is just for writing and I left some stuff out because it ended up being so long:

• Falling in water does kind of put A in a "dies horribly" camp, getting dunked in the cold is actually a really big deal. To survive that you'll need A to get warm and dry really fast, and you'll probably want to keep in mind what they're wearing too. Wool and some synthetics preserve heat when wet, cotton/linen leeches heat.

• Just looking up symptoms of hypothermia online, it lines up fine with what I've got. I do want to specifically highlight confusion, though. B might end up doing a lot to try to keep them from unwrapping themselves from blankets, trying to leave, etc. It doesn't matter if they can't really go anywhere, it won't stop them from trying, trust me. Relatedly, the level of incapacitated you want is good!

• B needs to keep them warm, layer blankets over and under them so they aren't on a cold surface, share body heat, use heat packs (someone else mentioned homemade ones out of bricks) just... anything. A lot of people mentioned skin-to-skin rewarming, but if they have warm, dry clothes available, I'd put those on A once B has to leave do things like light a fire. You can still include it, they'll probably just want to be dressed at some point, since it's extended and eventually that's warmer. A might start getting sick later on in the three days. B will need to make sure A is hydrated. The symptoms you guessed are good, if it's just being fended off! It'll probably start worse and improve slightly once they get a little warmer, but not much.

• Everyone who said frostbite is right! It's important to keep A's limbs warm. The body prioritizes heat and circulation to the core, so frostbite will be an ongoing risk, especially since anything frostbitten and rewarmed might freeze again, which is really bad. I checked what's just online for signs of frostbite and it's good for writing. Frostbitten tissue also gets damaged really easily, between the frostbite itself and the fact that the person can't feel it, that's why you shouldn't rub/massage it.

• Honestly A would need a bit to recover from just this even without any lingering effects, it's a lot of stress on the body. Something like pneumonia is a lingering effect I found that'd be the most practical for most stories, but pneumonia's a long recovery time, and I get it with The Plot. A really common injury with people who fall through ice is also a broken leg if you wanted something totally different. Frostbite would also for sure cause effects while it heals, probably similar to burns, or even permanent damage/needing a fingertip/whatnot to be amputated.

Anyway, on my last awful note, everyone else has said solid things! I tried not to rehash anything anyone else said. The only thing I want to say that you really shouldn't do is add a concussion, since that got pitched, that'll make everything worse. I know this is very long, but I hope something in it helps. If you have more questions, I will either answer them or try to find answers!

[(Anonymous)]

Three days in below freezing temps, even out of the wind with blankets and a fire isn’t going to be mild hypothermia. If A has fallen thru ice, B definitely won’t have to worry about caring for them for three days, because they won’t make it past a few hours (sorry).

For additional context, an “extremely” physically fit younger adult wearing typical swim attire can survive in 80 degree Fahrenheit water (tropical) for a MAXIMUM of three days before they die of hypothermia. This is extended for about another day if they’re wearing a life jacket, as it keeps more of the torso out of the water.

I do maritime search and rescue and there was a group of divers in 75 degree (still tropical area) water for about 3.5 hours, wearing 3-5mm wetsuits and floating huddled together, buoyant from their dive BCDs. They were all shivering, miserable, couldn’t feel their toes and fingers, dehydrated (less of a hypothermia issue), sunburned, massive headaches, and I believe three of them were vomiting.

Hypothermia is no joke!!!! For plot reasons, I’d recommend that the shelter they find is better than freezing. B should be able to exist near the fire or wrapped in a blanket and be chilly but alright if you want A to survive.