Hypothermia as a risk factor for injury outcome: are we really serious?

Effective military prehospital care must deliver a warm, non-coagulopathic patient to surgical care, addressing the lethal triad of hypothermia, acidosis and coagulopathy. Despite advances in haemorrhage control, hypothermia prevention remains underdeveloped, with little improvement in incidence over two decades. Renewed focus on European and cold-weather operations highlights the urgent need for improved thermal management during prolonged evacuation.Casualties lose heat through conduction, convection, evaporation and radiation, yet prehospital practice often relies on ineffective foil blankets and inconsistent protocols. Accurate temperature monitoring and standardised, symptom-based staging are needed for North Atlantic Treaty Organization interoperability.This paper advocates the '4Cs' (Consider, Conserve, Create and Continue) and Hypothermia Emergency Response Approach 7 framework to guide effective packaging, insulation and rewarming. Recommendations include adopting common staging systems, measurable insulation standards and equipment optimised for cold environments. Implementing these measures could markedly reduce hypothermia-related mortality in military trauma care.