a. Take early and aggressive steps to prevent further body heat loss and add external heat, when possible, for both trauma and severely burned casualties.

b. Minimize casualty’s exposure to cold ground, wind and air temperatures. Place insulation material between the casualty and any cold surface as soon as possible. Keep protective gear on or with the casualty if feasible.

c. Replace wet clothing with dry clothing, if possible, and protect from further heat loss.

d. Place an active heating blanket on the casualty’s anterior torso and under the arms in the axillae (to prevent burns, do not place any active heating source directly on the skin or wrap around the torso).

e. Enclose the casualty with the exterior impermeable enclosure bag.

f. As soon as possible, upgrade hypothermia enclosure system to a well-insulated enclosure system using a hooded sleeping bag or other readily available insulation inside the enclosure bag/external vapor barrier shell.

g. Pre-stage an insulated hypothermia enclosure system with external active heating for transition from the non-insulated hypothermia enclosure systems; seek to improve upon existing enclosure system when possible.

h. Use a battery-powered warming device to deliver IV/IO resuscitation fluids, in accordance with current CoTCCC guidelines, at flow rate up to 150 ml/min with a 38°C output temperature.

i. Protect the casualty from exposure to wind and precipitation on any evacuation platform.