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How to Stay Safe in Extreme Cold

Older people especially face dangers in lower temperatures and wind chills

spinner image a man walks his dog along the sidewalk during a snowstorm in Iowa
Rachel Mummey/Bloomberg via Getty Images

Winter can bring arctic blasts, snowstorms, ice and sleet. And more often these days, areas of the country unaccustomed to that type of severe weather are experiencing just that.

During those weather events, many may lose power, and therefore heat, which can lead to medical emergencies such as frostbite and hypothermia.​

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Older people are especially vulnerable when temperatures drop because they have less efficient circulation. They may have medical conditions (such as thyroid problems or diabetes) and take medications (such as beta-blockers) that can raise their risk of health problems, including injuries, in the cold, says Matthew Levy, D.O., associate professor of emergency medicine at the Johns Hopkins University School of Medicine. “Bone density decreases, which could put someone at risk for injuries from falls, and blood pressure medicine may not allow your heart rate to increase as needed” when shoveling snow.

Medical emergencies caused by cold

Hypothermia. This occurs when one’s body temperature, normally around 98.6°F, sinks below 95°F — a medical emergency that can cause cardiac arrest and death, as the cold causes arteries and blood vessels to narrow, which limits the amount of oxygen flowing to the heart. The temperature doesn’t need to be below freezing to cause this condition, but just cold enough to lower body heat by a few degrees. Warning signs include shivering, confusion, shallow breathing and drowsiness.

How to treat it: Call an ambulance immediately. While you wait, keep the person warm and dry, using blankets or anything you have on hand. If the person is able to drink, give him or her a warm beverage without alcohol.

Frostbite. As blood flow is focused away from fingers and toes to keep up core body temperature, the extremities suffer — fingers, toes, nose and ears. The skin starts to tingle (an early stage called frostnip), then feel numb, and may look grayish or white. In extreme cases, it can turn black as skin dies. Because frostbite begins with numbness, Factora says, it’s a good idea to check your fingers and toes when you are able to do so safely. It can become excruciatingly painful.

How to treat it: Warm water immersion is a standard treatment. If the skin is waxy and pale, however, “you want to avoid partially rewarming and having it refreeze,” Levy says. If possible, first get the person where he or she can stay warm.

Another issue is a decrease in muscle mass, says Ronan Factora, M.D., a geriatric medicine specialist at the Cleveland Clinic in Ohio. Normal muscle “is what twitches and creates heat when we shiver.” Because we have less muscle when we’re older, we’re less able to generate that vital heat, Factora says.

How to protect yourself in frigid temperatures

Pile on the layers. If you have no heat in your home, gather all blankets, coats, sleeping bags — anything that will allow you to maintain your body temperature — and bundle up. If your car is in a garage and you can’t open the garage door, don’t run the vehicle’s heater to get warm or charge devices.

Be careful with candles. If possible, use a flashlight as a light source instead of candles, which are a fire hazard.​

Keep the weather outside. Do anything you can to maintain the temperature indoors if you don’t have a heat source (or even if you do). The National Institute on Aging suggests that you keep blinds and curtains closed and roll towels and place them under doors to keep out drafts. Close the doors to unused rooms and avoid opening doors to the outside unless absolutely necessary.​

Prevent falls. You can get a range of injuries from falling on slick surfaces even if you have good balance, says Elizabeth Phelan, M.D., professor of gerontology and geriatric medicine and medical director of the Fall Prevention Clinic at Harborview Medical Center in Seattle. ​“Research out of Nordic countries and the UK shows that there’s double to triple the number of emergency room visits and hospitalizations due to falls from ice and snow,” Phelan says. ​​Her tips if you need to go outside when it’s icy: Wear slip-resistant footwear; keep your hands free and out of your pockets in case you need to balance or brace yourself; limit the number of items you’re carrying so you’ll have better balance; and avoid looking at your phone while you’re walking.

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Take care with electric heaters and generators. When using a portable electric heater, follow safety tips from the Consumer Product Safety Commission to avoid fire. They include advice about making sure the device is not damaged in any way (is the cord hot when you plug it in?) and not leaving it unattended. Make sure the heater is at least 3 feet away from curtains or bedding.​Never use a gas-powered generator indoors; you can be poisoned by carbon monoxide, a colorless, odorless by-product. The American Red Cross has tips on preventing carbon monoxide poisoning.​

Useful Resources FEMA’s advice on preparing for disasters and emergencies​
First aid app: The Red Cross’ free app with advice on handling many common emergencies​

Avoid alcohol. Alcohol can make you feel warmer, but it actually lowers the body’s temperature because it dilates your blood vessels and causes blood to flow from your core to your extremities. Too much alcohol will impair your judgment — not something you want in a weather emergency.​

Don’t drink melted snow. If you don’t have water, try to avoid drinking melted snow, which can be full of impurities. “I would advise against drinking it unless there’s truly no other option,” Levy says. (It’s less risky if you boil it before drinking.)​

Dress right. Multiple thin layers can insulate you better than one thick layer. The Centers for Disease Control and Prevention suggests wearing an inner layer of wool, silk or polypropylene, which will hold more body heat than cotton. If you start to get too warm, take off a layer before you begin to sweat. (Sweat lowers your body temperature.) Mittens are warmer than gloves.​

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Be careful while clearing snow. Extreme exertion, such as shoveling, can lead to a heart attack. “People who aren’t normally used to doing such strenuous exercise should not shovel unless they literally have a clean bill of health from their doctor,” Levy says. Note that every winter brings distressing snowblower injuries. You can’t be too careful when using one.​

Find a shelter. If you’re unable to get warm at home or you’re far from home, go to a shelter or warming center if there is one nearby and you can get there safely. ​

spinner image a red Jeep stuck in the snow
Rachel Mummey/Bloomberg via Getty Images

Don’t drive unless you must. If you do, drive slowly — even if you have four-wheel or all-wheel drive, says Lee DeBell, an AARP Driver Safety instructor in New Hampshire. “Sometimes people feel overconfident” when they have those features, DeBell says. “But one of the biggest things in icy conditions is doing everything more slowly — taking turns, braking — than you normally would do.” Consider taking back roads, if they are plowed, because they “can have much less traffic and fewer accidents.” Before hitting the road, be sure to clear all the snow and ice off all the windows — not just the front windshield — so you have full visibility. Also clear the snow and ice from the top of the car to prevent it from blowing off on other vehicles and impeding their drivers’ visibility. (Doing so is required by law in New Hampshire.)

If you have time to plan before bad weather hits, prepare a winter survival kit to keep in your vehicle, including a change of clothes, blanket, food and water.​

Keep pets safe. Animals should be inside, but remember that they too can get cold — and hypothermia and frostbite. Keep them dry and warm using blankets and hot-water bottles if they seem dangerously cold. If you walk your dog outdoors, try to avoid areas that have been salted; the Humane Society of the United States warns that canines are at risk for salt poisoning because they often lick their paws after a walk.​

Keep an eye on the fridge and freezer. If you lose power, food can spoil — and eating spoiled food can make you sick. If you’ve been away from home and return to a working freezer, you might not realize that you had lost power and that the food had refrozen. Levy suggests a “life hack”: Freeze a cup of water inside the freezer, then put a penny on top. If you check the cup later and the penny has sunk, you know the water melted and refroze.

Check on others. When temperatures are extremely cold, check on more vulnerable family members and neighbors. Even if they’re indoors, they may be at risk. “You don’t have to be in a cabin in Montana to get hypothermia,” Levy notes.​

Editor's note: This article was originally published on February 17, 2021. It has been updated to reflect new information. 

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