Environmental emergencies: heat and cold

How to recognise and manage heat exhaustion, heatstroke and hypothermia in community and workplace settings.

What is heat & cold emergencies?

Heat illnesses range from heat cramps and exhaustion, where the body is struggling but still compensating, to heatstroke, where temperature regulation fails and body temperature rises to dangerous levels, risking organ failure. Symptoms can include heavy sweating, thirst, headache, dizziness, muscle cramps, nausea, confusion and, in heatstroke, hot dry skin, seizures and reduced consciousness.

Hypothermia occurs when body temperature drops below 35°C, often due to cold weather, immersion, inadequate clothing, impaired mobility or intoxication; signs include shivering, cold pale skin, slurred speech, clumsiness, confusion and, in severe cases, drowsiness, arrhythmias and cardiac arrest. Early recognition and gentle rewarming can prevent deterioration.

Heat-related illness and hypothermia cause preventable morbidity and mortality each year, particularly in older adults, people with long-term conditions and those exposed to extreme environments without adequate protection.

Who needs this skill?

Any environment with significant heat or cold exposure - outdoor work, poorly heated homes, nightlife, sports and events - needs basic competence in recognising and managing environmental emergencies.

Health & Social Care

In health and social care, staff must be alert to heat and cold stress in frail older adults, people with dementia, those on certain medications and patients in under- or over-heated environments, using local escalation pathways and safeguarding where neglect or self-neglect are factors.

Licensed venues & nightlife

In nightlife and licensed venues, heat can build up in crowded dancefloors and queues in cold weather can expose poorly clothed patrons to hypothermia; staff should notice unwell customers, move them to safer environments, start first aid and call 999 when red flags are present.

Schools

School trips, sports days, outdoor learning and under-heated buildings all create environmental risks; staff who can spot heat and cold problems early can prevent serious harm during routine activities.

Workplaces

In workplaces, outdoor workers, factory staff, kitchen and cold-store workers are at particular risk; employers should undertake heat and cold stress risk assessments, provide PPE and breaks, and ensure first aiders can recognise when someone needs to be cooled or rewarmed and when 999 is required.

How to manage heat & cold emergencies

These steps set out how to recognise and manage heat exhaustion, heatstroke and hypothermia in everyday settings.

1

Recognise heat exhaustion and heatstroke

Look for headache, dizziness, nausea, heavy sweating, thirst and muscle cramps in heat exhaustion, and confusion, hot dry or very flushed skin, rapid pulse, seizures or reduced consciousness in suspected heatstroke.

Treat heatstroke as a medical emergency requiring 999 and rapid cooling, not just fluids and rest.

2

Move to a cooler or warmer environment and adjust clothing

For heat illness, move the person to shade or a cool indoor area, loosen or remove excess clothing and encourage cooling with fans or cool water sprays; for hypothermia, move them to a warm, sheltered environment if possible, remove wet clothing and replace with dry layers and blankets.

Avoid exposing hypothermic casualties to direct heat sources like hot baths or fires, which can cause dangerous afterdrop.

3

Cool or warm the casualty appropriately

For heat exhaustion, offer cool oral fluids if the person is conscious and not nauseated, and use cool packs in armpits and groin; for suspected heatstroke, begin more active cooling with cool water immersion, soaked sheets or spraying and fanning while awaiting ambulance.

For hypothermia, use gentle external rewarming with blankets, hats and warm drinks if they are awake and able to swallow, avoiding vigorous rubbing or limb massage which can destabilise the heart.

4

Monitor for red flags and call 999

Red flags for heat include confusion, seizures, collapse and hot dry skin; for cold, look for confusion, extreme drowsiness, very slow breathing or pulse and collapse. Call 999 if any red flags are present or if there is no improvement with initial measures.

Tell call-handlers about environmental exposure, known conditions and treatments given so far.

5

Support airway, breathing and circulation and prevent further heat loss or gain

Continue to monitor airway, breathing and circulation, be ready to start CPR if needed and, for cold casualties, insulate underneath as well as on top to reduce conductive heat loss.

Avoid unnecessary movement of severely hypothermic casualties because of the risk of precipitating arrhythmias.

This guide is a learning reference only. It does not replace attended, assessed first aid training.

Qualifying courses

These courses all cover heat and cold emergencies at an appropriate level, with FREC and clinical modules exploring advanced temperature management and public health coordination. Choose the course that matches your role, sector, and the level of clinical practice required.

Qualsafe Level 3 Award in First Aid at Work (RQF)

3 days

3 years

Learn More

Qualsafe Level 3 Award in Paediatric First Aid (RQF)

EYFS recognised paediatric first aid

2 days

3 years

Qualsafe Level 3 Award in Emergency Paediatric First Aid (RQF)

EYFS recognised paediatric first aid

1 day

3 years

Learn More

Qualsafe Level 2 Award in Activity First Aid (RQF)

Extremes of heat and cold in outdoor activities

2 days

3 years

Learn More

Common questions

Practical answers for employers, venue managers, and healthcare teams about heat & cold emergencies training.

Can't find your answer? Contact us.

B

Is it true you should not give drinks in heatstroke?

In someone with reduced consciousness or vomiting, oral fluids are unsafe because of aspiration risk, and priority is rapid cooling and 999; in milder heat exhaustion, small sips of cool water or oral rehydration are appropriate.

B

Can hypothermia happen indoors?

Yes; frail or immobile people in poorly heated homes or care settings can develop hypothermia even without going outside, especially during cold snaps. Regular temperature monitoring and environmental checks are important in care.

B

Should I use hot water bottles or electric blankets for hypothermia?

These may be used cautiously under clinical guidance, but in first aid settings the focus should be on passive rewarming with layers and ambient warmth; direct intense heat can cause burns and afterdrop.

B

How quickly should I cool someone with heatstroke?

Evidence supports rapid cooling to reduce organ damage, ideally within 30 minutes of collapse, using whatever safe methods are available, such as immersion, soaked sheets or spraying and fanning.

B

How can organisations prepare for environmental emergencies?

Action plans for heatwaves and cold weather, clear staff roles, monitoring of indoor temperatures, provision of shade, hydration and warm clothing, and drills for outdoor events all improve preparedness.