Wilderness First Aid Q&A

How to prevent frostbite




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Before we even finish swallowing our holiday meals, it seems winter barges in to start blowing wind against our windows and to blanket our streets with snow. All around the country people are beginning to feel the chills of December and see their outfits get thicker and thicker as they try to shield themselves from the cold. Not only does being cold just not feel good, but it can also be dangerous to our skin, muscles, nerves, and bones. Frostbite is the end result of cold-induced injury to our tissues, and it is much more common than one may think!

Frostbite occurs by two related mechanisms. When we are exposed to very low, sub-freezing temperatures — meaning those temperatures below 0◦ Celsius or 32◦ Fahrenheit — the fluid outside and inside of our body’s cells starts to freeze. Eventually, ice crystals develop inside those cells just like they do to a roast beef stored in the freezer. The cells get directly damaged from this injury, and the body responds with an alphabet soup of “inflammatory signals” in an effort to patch things up. With time and sustained damage, the massive inflammation may further cut off the blood supply to the affected tissues, and the cells eventually begin to die in a process called necrosis.

Frostbite can be seen in varying degrees of severity:

  • Frostnip is the numbing or tingling sensation that occurs when exposed to cold for a short amount of time and does not lead to any permanent damage.
  • Immersion foot or trench foot is a result of prolonged exposure to the combination of wet and cold, like the environment many soldiers found themselves in during World War I, while fighting in the trenches.
  • Frostbite can vary in severity depending on how deep the ice crystals form: Does the injury remain in the superficial part of the skin or does it extend deeper into the fat and muscle? The most distant parts of our body, to which blood must travel the farthest, are the ones most affected by frostbite—ears, cheeks, nose, hands and feet. Damaged skin can look differently depending on the depth of necrosis; it can be gray, yellow or blue in color, have large fluid filled blisters (called bullae), or be completely black and numb.

Certain behaviors may increase a person’s risk for developing frostbite. For example, alcohol use can lead to poor decisions in which the affected person may wear improper clothing for the cold temperatures. More importantly, alcohol makes our body believe that it is actually warmer outside than it really is, so our body tries to cool itself down — not realizing that it is increasing susceptibility to frostbite! Other risks include cigarette smoking, which damages blood vessels and decreases the amount of blood that can reach body parts most affected by the cold.

Frostbite can also occur by direct exposure to objects that are freezing cold, including ice-packs stored in a backpack, for example! That is why it is important to always put something between your skin and the icepack (like a cloth), and to limit the time spent in direct contact with an icepack to no more than 20-minutes.

There are other ways to prevent frostbite. The simplest way is to actually listen to your mom and dress warm. A professional guide to how to prepare for a cold front includes wearing an inner-most polypropylene layer that will wick moisture away from your skin, topped off by an insulating wool or fleece layer and capped with a wind, rain and snow protector like a waterproof jacket. If the clothing gets wet, change it as soon as possible so your skin is not damp for a prolonged amount of time. Of course, don’t forget to stay well hydrated and well-fed so your body has the energy to plow through the snow and wind and return home.

However, if frostbite has set-in, then you can fight back by getting to a warm place as soon as possible. Re-warming can be done by placing the affected part of the body into warm, (NOT hot!) water, or with body heat (arm pits are one of the warmest parts of our body!)

Without proper treatment frostbite can lead to permanent damage to your nerves leading to loss of sensation and movement! It can even lead to large infections which sometimes can only be cured by amputation. Thus, any sign of frostbite is a medical emergency!

As the temperatures drop below freezing in the upcoming months, just remember that frostbite is a realistic danger that can be easily prevented with some forethought and planning. A pair of warm armpits can help, too!

Comments about “How to prevent frostbite”

  1. john says:

    nice cool article

  2. Mom of a boy who wouldn't dress warm says:

    Really good article from a real professional….I am going to show it to my boy (and his father!) to let them know that dressing warm is a wise thing to do…especially when going out in the cold.

  3. Bob says:

    Very interesting information, well done!

  4. Jack Frost says:

    Great article! Where do you guys learn all this stuff from?

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  • Dr. Andrew C. Krakowski is the host of the boonDOCS Wilderness & Travel Medicine show on Outdoor Channel. He is the founder of the Johns Hopkins School of Medicine's wilderness medicine program and currently works in the field of pediatric dermatology at the Rady Children's Hospital in San Diego.

    Dr. K loves the outdoors and believes that knowledge, adaptability, and experience are essential for being prepared in the wilderness.

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