Royal Army College

Lesson Overview

A winter welfare operation has one danger above all others: the cold itself. The same weather that makes the work necessary is the thing most likely to harm the people you serve, and you. A wet, exhausted, unsheltered person can decline through a hard winter night faster than most people expect, and do so quietly, without any cry for help.

This lesson teaches you to take the cold seriously: to know who is most at risk, to find the people the cold is quietly harming, to approach them with dignity, to recognise hypothermia and cold injury early, to warm a person safely within your training, to get them to shelter, and to manage your own cold discipline so you remain a help and not a second casualty. The clinical treatment of hypothermia and cold injury is not taught here. That is earned in person, under qualified supervision, in the Combat First Aid course. Here you learn to recognise cold harm, give sound welfare first response, and know the exact point at which recognition is handed to first aid and to medical or emergency help. This lesson builds on the first aid taught in Basic Training Module 12 and assumes it. By the end you will be able to carry out a welfare round, warm a person safely, spot the warning signs of cold harm, do the right things and avoid the wrong ones, and know the point at which buddy aid stops and medical or emergency help must be called.

Key Terms

Hypothermia: a dangerous fall in the body's core temperature, in which the body can no longer keep itself warm. It impairs the mind as well as the body and can be fatal.
Cold injury: localised damage from cold, such as frostbite to the fingers, toes, ears, and nose, or the softer damage of prolonged wet and cold.
The "umbles": a memory aid for the early signs that someone is losing the fight against the cold: they stumble, mumble, fumble, and grumble.
Welfare round: the planned circuit a team walks or drives to find people out in the cold, check on them, give warmth and food, and signpost them to shelter.
Signposting: pointing or helping a person on to a service that can do more for them than you can, such as a night shelter, a warm centre, or a medical or social-care service.
Buddy aid: the immediate help that members give within their training before, or in place of, professional medical care.
Rewarming: raising a cold person's temperature; in welfare work, gentle, gradual warming, never rapid or fierce heat.

Why cold is the central danger

In a winter operation the cold is not the backdrop to the work; it is the threat the work exists to answer. Exposure can injure and kill on its own, and it does its worst at night, when temperatures fall, help is thinnest, and a sleeping person cannot judge their own decline. Wind and wet make it far worse: moving air and damp clothing strip heat from the body many times faster than still, dry cold of the same temperature. A person need not be in deep frost to be in danger. The temperature may sit only a little above freezing, yet a soaked, still, undernourished person loses heat for hours and slides into hypothermia all the same. A wet night that does not feel deadly can be exactly that.

The cruelty of hypothermia is that it disables the very judgement a person would need to save themselves. As they cool, they grow confused and drowsy, stop feeling the urgency of their situation, and may even feel deceptively warm. They will not always ask for help, and may refuse it, not from stubbornness but because the cold has clouded their thinking. This is why a welfare team goes looking, gently and watchfully, rather than waiting to be called. The people most exposed to a hard winter are exactly the people a small, disciplined force can reach on a cold night when other services are stretched thin: the homeless and rough sleepers, the old living without fuel, the very young, the sick, those with no shelter. To find them, warm them, and pass them safely into better hands is humanitarian work of the plainest, most life-saving kind, owed to everyone by need alone.

Who is most at risk

Everyone exposed to a hard winter is at some risk, but certain people are far more vulnerable, and they are exactly the people a welfare team is most likely to meet. The cold weighs hardest on the body that makes least heat, loses it fastest, or can least judge its own danger.

The unsheltered, the rough sleepers and homeless, who have no walls, roof, or heating between them and the weather.
The wet, whose clothing or bedding has been soaked by rain, snow, or sweat, and who are losing heat rapidly.
The exhausted and undernourished, whose bodies have little reserve left to generate warmth.
Those affected by alcohol or drugs, which dull the sense of cold, impair judgement, and, by opening the blood vessels at the skin, speed heat loss while making a person feel warm.
The old, whose bodies regulate temperature less well, who often live alone, and who may be without fuel or unable to afford to run it.
The very young, whose small bodies lose heat quickly relative to their size and who cannot speak their distress or take themselves to warmth.
The sick and those with long-term illness, whose bodies hold their temperature poorly and whose reserves are already spent.
Those without fuel or shelter, the household with a cold home and no money for heat, at real risk indoors, behind a closed door where no welfare round will find them unless someone thinks to ask.

A person may fall into several of these at once, and the danger stacks. The rough sleeper who is cold, wet, still, undernourished, often unwell, and sometimes drinking against the cold has nearly every risk factor pressing together. Treat anyone you find outdoors on a cold night as potentially at risk, ask after those who may be cold behind closed doors, and look the more carefully where these factors gather.

The welfare round: finding and checking on people in the cold

The heart of the work is the welfare round: the planned circuit a team walks or drives through a cold night to find people out in it, check on them, give warmth and food, and point or take them on to shelter. It is simple work done with great care, and most of its skill is in the manner, not the kit. The aim is to leave each person warmer, fed, and a little safer than you found them, and to miss no one.

Plan the round. Work to a route agreed with your team and with the civil authorities and shelter services who know the ground: the doorways, underpasses, stairwells, park benches, and quiet corners where people shelter, and the warm centres and night shelters you can send or bring people to. Go in pairs at least, never alone, for the reasons taught in Lesson 04 (Personal Safety and Risk Management). Carry a means of calling for help and the numbers for emergency services and the shelters, and know where your warming point and your vehicle are. A planned round finds people and gets them help; a round made up as it goes misses both.

Find people gently. Look where people shelter from the wind and wet, not where they are easy to see. A still bundle in a doorway, a figure on cold stone under a bridge, a tent in scrub, is a person to check. Use a light without dazzling. The people most in danger are often the quietest, because the cold has stilled them.

Approach with dignity. This is a person, not a problem to be processed. Approach slowly and from the front so as not to startle a sleeping or frightened person; in the dark, speak before you are close. Make yourself known kindly and plainly: who you are, that you are checking that people are all right in the cold, and that you have a hot drink, food, and warm kit if they would like them. Get down to their level rather than standing over them, and ask permission before you do anything, including before you shine a light closely or touch them. Many people you meet will be wary of a uniform, or have been let down before; your courtesy is what turns a stranger's approach into welcome help.

Check on them. While you talk, you are also reading the cold in them, by the signs taught below. Can they wake, speak clearly, and answer simple questions, or are they slow, slurring, vague, or drowsy? Are they shivering, or have they stopped? Are they wet? How are their hands, feet, and face? You learn most of this just by offering a drink and watching how they take it. Do it as a kindly conversation, not an examination.

Give warmth and food. Offer a warm, sweet drink and something to eat to anyone fully alert and able to take it, and the warm kit they need: a dry blanket, a hat, gloves, dry socks. Sit with them while they drink if they will let you. The detail of distribution belongs to Lesson 06 (Supplies, Distribution, and Working with Others), but on the round the warm drink and the dry sock are the heart of the kindness.

Signpost or take to shelter. Tell every person plainly what shelter is open, where it is, and how to get there, and offer to help them to it. Do not pressure; an adult may decline, and the section below explains how to hold that with both respect and concern. Note who declined and where, so a later round can check again.

Record and hand on. Keep a simple note of who you met, where, what you gave, what worried you, and what you arranged, so the team and the services can follow up and no one falls through the gap between one round and the next. Pass on at once anyone you are worried about.

A short checklist holds the round together. Carry it in your head, and on a card if it helps:

   THE WELFARE ROUND, AT A GLANCE

   PLAN     route, in pairs, means to call for help, where the
            warm point and the shelters are
   FIND     look where people shelter from wind and wet, not where
            they are easy to see; the quietest may be the coldest
   APPROACH from the front, speak first, get to their level, say who
            you are, ask permission, treat them as a person
   CHECK    can they wake and answer clearly? shivering or stopped?
            wet? hands, feet, face? read the cold while you talk
   WARM     warm sweet drink and food if fully alert; dry blanket,
            hat, gloves, dry socks; sit with them
   SHELTER  tell them what is open and where; help them to it; do
            not pressure an adult who declines
   RECORD   who, where, what you gave, what worried you, what you
            arranged; pass on anyone you are worried about

   Above all: DO NO HARM, and leave each person warmer, fed, and
   a little safer than you found them.

What to carry on the round

A welfare round is only as good as what the team carries, and in the cold a few humble items earn their weight many times over. The detail of stores belongs to Lesson 06, but you should know what matters most, so nothing essential is left in the vehicle. Carry warm, sweet drinks in flasks and high-energy food, because sugar and food give the body the fuel to make its own heat. Carry dry blankets and, where the operation provides them, insulated sleeping bags or survival blankets. Carry hats, gloves, and thick socks, since much heat leaves by the head, hands, and feet; a dry pair of socks is among the most useful things you can hand a person on a freezing night. Carry waterproof outer layers, and hand and body warmers. Carry a light, a means to call for help, and the numbers for the shelters and emergency services. Carry a simple way to record who you met. And carry the things that keep you going through the night, set out under your own cold discipline below, because a frozen helper helps no one.

Recognising hypothermia and cold injury

Recognising cold harm is the skill on which everything else turns: what you recognise you can act on and hand to first aid in time. Recognition is taught here in full; treatment is not.

Early hypothermia announces itself first through shivering and through the umbles: a person who stumbles, mumbles, fumbles with their hands, and grumbles or becomes withdrawn is telling you, without words, that the cold is winning. You will often see it in the small things on the round: a person fumbles and drops the cup you hand them, or answers a simple question slowly and a little strangely. Those small signs are the cold reaching the mind, and they are your early warning.

As it deepens, the signs become more serious, and one is dangerously misleading: the shivering stops. A person who was shivering and then ceases has not recovered; more often they have got worse, because the body has lost the energy to shiver. Look also for confusion, drowsiness, slurred speech, loss of coordination, cold and pale skin, and a person who is hard to rouse. A casualty who stops shivering, grows confused or sleepy, or cannot be roused is a medical emergency.

Cold injury is more local. In frostnip, the early and milder stage, the skin of an exposed part begins to freeze and turns pale; it is a warning to protect that part at once. In frostbite, the skin and the flesh beneath it actually freeze, most often at the fingers, toes, ears, nose, and cheeks. The area may look white, grey, or waxy, feel hard or numb, and lose its normal colour and feeling. Wet, cold feet kept too long in soaked boots and socks can also be damaged even without freezing, an injury sometimes called trench foot or immersion foot, a real danger in a wet winter where feet stay soaked for hours without ever quite freezing. Treat any numb, white, waxy, discoloured, or hardened skin seriously, protect it from further cold at once, and remember the firm rule of this lesson: you recognise cold injury and protect the part; you do not treat it. The clinical care belongs to first aid and qualified medical staff.

The recognise-then-hand-on rule is the spine of cold welfare. Hold it like this:

   RECOGNISE  -->  PROTECT  -->  HAND TO FIRST AID / MEDICAL HELP

   See the signs of    Stop further       Get qualified care:
   hypothermia or      heat loss;         Combat First Aid drills,
   cold injury         warm gently;       the medical officer,
                       handle with care   or emergency services

   You RECOGNISE and give gentle welfare first response.
   You do NOT diagnose or clinically TREAT.
   Clinical treatment of cold injury is taught and certified
   in person in the Combat First Aid course, never learned
   for the first time on a casualty.

The right response: warming a person safely

For someone suffering from the cold, your aims are to stop further heat loss and to warm them gently while you get the right help. This is welfare first response, given with care and within your training, and it is deliberately simple, because it must work on a freezing night, in the dark, with cold hands.

Move them to warmth and shelter. Get the person out of the wind and wet and into a warmer place, a vehicle, a building, a warm centre, or at least a sheltered spot off cold ground. Wind and wet are the great heat thieves, and getting a person out of both does more than anything else you can do.
Insulate them from the ground. Cold ground draws heat by direct contact faster than cold air does, so a person on frozen stone or wet earth keeps losing heat even under blankets. Get something insulating, a mat, folded blankets, cardboard, a sleeping bag, between them and the ground before you do much else.
Remove wet clothing. Wet layers go on stripping heat; replace them with dry clothing, blankets, or a warmed covering, including something over the head. Do this while preserving the person's dignity and consent: explain, ask, shield them from view, and change one part at a time rather than baring them to the cold all at once.
Add dry layers and cover them well. Dry insulation traps the body's own warmth and lets it build. Cover the head and neck, tuck in the edges, and wrap rather than pile.
Rewarm gently, with shared and ambient warmth. Let warmth return gradually. The body's own heat held in by dry insulation, the shared warmth of a warm person close by, and the gentle, even heat of a warm room or vehicle are all safe. Fierce or direct heat is not (see below). Warm the trunk and core rather than aiming heat at cold hands and feet.
Offer warm, sweet drinks, but only if the person is fully conscious and able to hold and swallow them safely. Sugar gives the body fuel to make heat, and the drink comforts as well as warms. Never give drink to anyone drowsy, confused, or not fully alert, because they may not be able to swallow safely.
Handle them gently. A very cold body can be fragile, and rough or sudden handling can do harm. Move and reposition such a casualty slowly and carefully.
Stay with them and keep watching. A person can decline while you are warming them, so keep reading the signs and be ready to call for help the moment they worsen.

The whole of recognising and responding can be held as one simple line of decision. Read it from the top:

   SUSPECTED HYPOTHERMIA: RECOGNISE, THEN RESPOND

   Cold person, with shivering and the "umbles"
   (stumbles, mumbles, fumbles, grumbles)
                 |
                 v
   Has the shivering STOPPED, or are they CONFUSED,
   DROWSY, or HARD TO ROUSE?
                 |
        +--------+--------+
        |                 |
       YES                NO
        |                 |
        v                 |
   MEDICAL EMERGENCY:     |
   call for help NOW;     |
   handle very gently  ---+---> Act within your training:
                          |
                          1. Move out of wind and wet, into warmth
                          2. Insulate from the cold ground
                          3. Remove wet clothing; dry layers; cover head
                          4. Rewarm gently; shared and ambient warmth
                          5. Warm sweet drinks ONLY if fully conscious
                          6. Handle gently; stay with them; keep watching

   NEVER: alcohol; rubbing frozen skin; fierce or direct heat.
   When in doubt about how serious it is, CALL.

What not to do

Some instinctive responses to cold are actively harmful, and you must know them as surely as the right steps, because a well-meant wrong move can do real damage. With a cold casualty:

Give no alcohol. It feels warming but opens the blood vessels at the skin and speeds heat loss, while clouding judgement further. A nip against the cold is one of the oldest and most dangerous mistakes.
Do not rub frostbitten skin, or rub the body with snow. Rubbing frozen tissue tears and damages it. Protect and cover the area instead, keep it still, and do not let it thaw and then refreeze.
Use no rapid or direct heat on cold parts. Keep the casualty away from fierce fires, heaters held close, and very hot water on cold limbs. Sudden, direct heat can injure cold tissue and can be dangerous to a deeply cold person. Warm gradually, and warm the core rather than scorching the extremities.
Do not let a drowsy person simply "sleep it off" in the cold, and do not assume someone is merely drunk. A cold person allowed to drift off may not wake. Assume cold until you are sure otherwise.
Do not seal a person into an unventilated space with an engine or a flame. Warming a person in a closed vehicle with the engine running, or in a small space with a stove or heater, risks carbon monoxide, a colourless, odourless, poisonous gas whose early effects of drowsiness and confusion mimic the very cold you are treating. Warm them, but keep fresh air always moving. This danger is taught in full in the Cold-Weather Operations and Survival course.

The special care of children and the old

Two groups need particular thought in the cold, because they are both more vulnerable and less able to speak their danger. Children, and the very young most of all, lose heat quickly relative to their small size, have little reserve, and cannot always tell you that they are cold or take themselves to warmth; a quiet, floppy, drowsy child is a serious worry, not a sleepy one. Keep a cold child's head covered, warm them against an adult's body where you can, get them out of the wind and off the ground first, and treat any drowsiness or unusual quietness as urgent. Where a child is involved, the safeguarding duties taught in Lesson 08 (Difficult Situations, Safeguarding, and Self-Care) apply alongside the cold welfare; a child at risk in the cold is a matter to raise and hand on without delay.

The old regulate their temperature less well, often feel the cold less than they should, and may be in real danger indoors as well as out: a cold home, no fuel, or no money for heating can chill an older person behind a closed door where no round will find them. They may also be reluctant to make a fuss or accept help. Approach with extra patience and respect, do not assume that "managing" means safe, ask gently about heating and warmth, warm them slowly, and remember that confusion in an older cold person may be the cold and not their usual state. For both the very young and the old, the rule is the same as for anyone, only more so: recognise early, warm gently, and hand on to medical help and the social-care services sooner rather than later.

Shelter: getting people to a warm place

The surest answer to the cold is a warm, dry place out of the wind, and a large part of welfare work is helping people reach one. Know, before you go out, what is open: the night shelters, the warm centres, the places that take people in on a cold night, and how to get a person there. On the round, signposting means telling a person plainly and kindly what is open, where it is, and how to reach it, and offering to help them to it, to walk or drive them, or to make the call that arranges a place. For someone who cannot get there alone, helping them to shelter may be the single most useful thing you do all night.

Two things temper this. First, respect the adult's choice. A person of sound mind may decline shelter, for reasons of their own that are not yours to overrule, and pressing or coercing them is neither lawful nor kind. Offer plainly, make sure they know what is open and how to reach it, leave them warmer and better equipped than you found them, and arrange for them to be checked again. Second, the clouded mind is different. When a person is so cold that their judgement is failing, by the signs of hypothermia, their refusal is the cold talking, not a free choice, and the situation is no longer a matter of preference but of safety: that is the point at which you call for medical or emergency help. Holding both together, the deep respect owed to a free adult and the duty of care owed to a person whose mind the cold has taken, is the hardest judgement of the work, met by reading the cold carefully and erring, when truly unsure, towards safety and a call for help.

Your own cold discipline

You cannot help others if the cold defeats you, so look after yourself and your team with the same seriousness you give to those you serve; a welfare member who becomes a casualty has not helped but added to the emergency. Dress in layers you can add and remove, so you neither freeze nor sweat; a sweat-soaked layer becomes a danger when you stop moving. Stay dry: keep wind and wet out, and change wet gloves and socks before they chill you. Eat and drink warm through the task, because your body needs fuel to make heat, just as the people you help do.

Watch your teammates as closely as you watch those you serve, because a person rarely notices their own decline. Call out the umbles in each other without embarrassment. Take the scheduled breaks to warm up in the vehicle or a warm point; these are not a weakness in the plan but part of it, and skipping them is how teams come to grief. Rotate the coldest jobs so no one is left out in the worst of it too long. A clear-headed, warm helper is the one who notices the quiet figure in the doorway and reads the cold in them in time. This runs alongside Lesson 04, on keeping yourself and your team safe, and Lesson 08, on looking after one another after hard work, and in step with the field-living and survival skills of the Cold-Weather Operations and Survival course and the welfare standards of the Field Health, Hygiene, and Sanitation course.

The limits of buddy aid

Buddy aid saves life by buying time, but it has firm limits, and knowing them is part of doing it well. The knowledge is studied here; the practical and clinical skills are certified in person under qualified supervision and the medical officer, never learned for the first time on a casualty. You are there to recognise cold harm, give immediate, gentle welfare care, and summon those who can do more, not to manage a serious medical emergency alone. Call medical or emergency services without delay if a person:

has stopped shivering and is confused, very drowsy, or hard to rouse;
is unconscious, breathing abnormally, or unresponsive;
has frostbite that is more than superficial, or any injury beyond simple first aid;
is a child or an older person you are seriously worried about;
is not improving, or is worsening, despite your first response;
or whenever you are unsure how serious their condition is.

When in doubt, call. It is always better to summon help that proves not to be needed than to withhold it from someone sinking quietly in the cold. Give what gentle care you can while help is on its way, keep the person sheltered and insulated, stay with them, and hand them over cleanly when help arrives, telling those who take over what you saw and what you did. The clinical treatment of hypothermia and cold injury is taught and certified in person in the Combat First Aid course; the field health that protects vulnerable people at a welfare site is taught in the Field Health, Hygiene, and Sanitation course; and the wider winter survival and rescue skills are taught in the Cold-Weather Operations and Survival course. This lesson recognises, responds, and hands on; it does not treat.

In Practice: A cold-weather welfare check at night

Late on a freezing night in a winter town, working a planned welfare round with your partner, you come upon a person lying outdoors in the lee of a wall. Work calmly through the routine you have learned. Approach from the front and speak before you are close, get down to their level, and say who you are and that you have a hot drink and warm kit; you keep the Lesson 04 hazards in mind and your partner with you. Rouse and check: can they wake, speak clearly, and answer simply, or are they drowsy, confused, or slurring? Are they shivering, or have they stopped? Are they wet? How are their hands, feet, and face? You learn much of this just by handing over the cup and watching how they take it. Act: get them out of the wind and off the cold ground with something insulating beneath them, replace wet layers with dry ones and cover their head, and, if they are fully alert, give a warm sweet drink and something to eat. Decide: if they are alert and improving, keep warming them, tell them about the shelter that is open and how to reach it, and offer to help them to it; if they are drowsy, confused, hard to rouse, or not improving, call emergency services at once and keep warming gently while you wait, never sealing them into an unventilated vehicle. Throughout, you treat them as a person and not a problem: you speak kindly, explain what you are doing, seek their consent, and protect their dignity, even as you act quickly against the cold. Before you move on, you note who you met, where, what you gave, and what you arranged, so no one is lost between this round and the next.

Check Your Understanding

Name four kinds of people who are at higher risk in cold weather, and say why each is more vulnerable.
Why is it dangerous when a shivering person stops shivering, and what other signs would tell you their hypothermia is becoming serious?
Give three things you must NOT do for a cold casualty, and explain the harm each would cause.

Reflection (write a short paragraph): Imagine finding someone on a freezing night who insists they are "fine" and waves you away, but who is slurring their words and fumbling with their hands. What does this lesson tell you might be happening, and how would you balance respecting their wishes against the duty to keep them safe?

Summary

In a winter operation the cold is the central danger: it can kill on its own, does its worst at night, and clouds the judgement of those it is harming, which is why a team goes looking rather than waiting to be called.
Those most at risk are the unsheltered and rough sleepers, the wet, the exhausted and undernourished, those affected by alcohol, the old, the very young, the sick, and those without fuel or shelter, including behind closed doors.
Run the welfare round in pairs to a planned route; find people where they shelter from wind and wet; approach with dignity from the front; check by reading the cold as you talk; give a warm drink, food, and dry kit; signpost or take them to shelter; and record and hand on anyone you are worried about. Do no harm; leave each person warmer, fed, and safer.
Recognise hypothermia by shivering and the umbles (stumbles, mumbles, fumbles, grumbles), and treat the stopping of shivering, confusion, and drowsiness as serious. Watch for the white or waxy skin of frostnip and frostbite on fingers, toes, ears, and nose, and for wet, cold feet. Recognition leads to first aid and medical help, never to amateur treatment.
Warm a person safely by moving them out of wind and wet, insulating them from the ground, replacing wet clothing with dry, rewarming gently with shared and ambient warmth, giving warm sweet drinks only if fully conscious, and handling them gently. Never give alcohol, rub frostbite, apply rapid or direct heat, or seal them in an unventilated space with an engine or flame.
Give children and the old particular care, get people to a warm place while respecting an adult's free choice, and keep your own cold discipline so you stay effective and do not become a second casualty. Buddy aid buys time; it does not replace the professionals. See also Lesson 04, Lesson 08, the Combat First Aid course, the Field Health, Hygiene, and Sanitation course, the Cold-Weather Operations and Survival course, and Basic Training Module 12 (First Aid).

Cold-Weather Welfare and First Response