Australia isn’t known for its freezing weather generally, but cold exposure still happens — especially during outdoor work, camping, or water activities. Recognising this, the Australian and New Zealand Committee on Resuscitation (ANZCOR) has updated its Guideline 9.3.3: First Aid Management of Hypothermia and Cold-Related Injuries to reflect the latest evidence.
The changes are designed to make first aid safer, clearer, and more practical for the community.
1. The guideline now covers all cold-related injuries
Previously, this guideline focused only on hypothermia. The update now includes frostbite and non-freezing cold injuries (such as chilblains and trench foot). This means first aiders are now guided on how to manage both whole-body cold exposure and localised tissue damage.
For example, it explains how to identify frostbite — white or waxy skin, loss of feeling, or hard tissue — and provides clear instructions on how to rewarm safely without causing further harm.
2. Clearer definitions of hypothermia stages
The guideline now divides hypothermia into three categories:
- Mild (32–35°C): Shivering, pale skin, cold sensation, and tiredness
- Moderate (28–32°C): Slurred speech, clumsiness, confusion
- Severe (<28°C): Unconsciousness, weak or absent pulse, slow breathing
This helps first aiders recognise early warning signs and adjust their response depending on the stage.
3. Updated CPR recommendations for severe hypothermia
In very cold environments, continuous CPR can be difficult. ANZCOR now states that:
- CPR can be delayed up to 10 minutes if it’s necessary to move the person to a safer or more sheltered area.
- If continuous CPR isn’t possible (for example, during evacuation), it may be done intermittently — 5 minutes on, 5 minutes off — until proper help arrives.
This change acknowledges that in extreme cold, the body’s metabolism slows so much that brain injury takes longer to occur, meaning resuscitation efforts can still be successful after longer downtimes.
4. Stronger focus on active rewarming
The older guideline recommended mainly passive warming (blankets, removing wet clothing). The new version introduces active rewarming — such as applying body heat or warm packs to the chest, neck, and armpits.
It also clarifies what not to do:
- Don’t use direct heat (like a fire or hot water bottle).
- Don’t rub or massage cold limbs.
- Avoid giving alcohol or caffeine.
Active but safe rewarming methods can be life-saving when used correctly.
5. Added emphasis on prevention
ANZCOR now includes a dedicated prevention section. It stresses preparation and risk reduction, including:
- Wearing layered clothing that stays dry
- Staying well-nourished and hydrated
- Avoiding prolonged wet or windy exposure
- Monitoring each other for signs of cold stress
This is especially important for outdoor workers, boaters, hikers, and surf lifesavers who may spend long periods in cold, wet, or windy conditions.
6. Frostbite and non-freezing injury management
New recommendations include:
- Remove wet or tight clothing and jewellery from affected areas.
- Rewarm gradually in warm (37–39°C) water for 15–30 minutes.
- Do not rub or massage frozen skin — this can worsen tissue damage.
- Do not allow refreezing after rewarming.
- Cover the injury with light, non-stick dressings and seek medical care.
These updates help ensure that even those without medical equipment can still provide effective early treatment.
7. New advice for rescuers
The guideline now reminds first aiders to protect themselves. A rescuer can also develop hypothermia if exposed to cold or wet conditions for too long. Training now includes how to manage patients while preventing self-risk.
Why these updates matter
These updates make first aid training more realistic and better suited to modern outdoor lifestyles. Understanding how to recognise, manage, and prevent cold-related injuries means you can make informed decisions when seconds count.
Whether you’re an outdoor enthusiast, parent, coach, or worker in the elements — being trained to the latest standards ensures you can act confidently in emergencies.
Stay Current With Best Practice
Our nationally recognised First Aid and CPR courses now incorporate these updated guidelines in the First Aid Management of Hypothermia and Cold-Related Injuries ensuring you’re trained to respond confidently and correctly in real emergencies.
Check out our upcoming first aid course dates in Port Macquarie and Taree and enrol in a course today to refresh your skills, stay compliant with current standards, and be ready to provide lifesaving care when it matters most.
