Few UK emergency departments have a hypothermia protocol. This must change > “Failure to prepare is preparing to fail” (Benjamin Franklin) Rarely, does a British winter go by without a headline such as “Stranded climber dies from hypothermia.” Despite the media focus, only about five cases of severe hypothermia occur each year on British mountains. Hypothermia is more common in urban areas and was an important factor in the deaths of 166 people in the United Kingdom in 2012. In these cases, other factors often included alcohol intoxication, drug overdose, and mental illness. Although cardiopulmonary bypass, and more recently extracorporeal membrane oxygenation (ECMO), have been used in many countries since the late 1960s to rewarm people with hypothermic cardiac arrest,1 2 these techniques have rarely been used for this purpose in the UK.3 In the 1990s, several papers were published on the successful use of cardiopulmonary bypass to rewarm patients with hypothermic cardiac arrest. In 2005, the European Resuscitation Council (ERC) guidelines recognised this technique as the preferred method of active rewarming in hypothermic cardiac arrest. The remarkable survival of a patient from a core temperature of 13.7°C showed what is possible.4 The phrase “not dead until warm and dead” is well known and often quoted …