Hypothermia and Other Cold Weather Injuries, Part II

by mobrian on February 22, 2009

Part II, Related Cold Weather Injuries

Make sure you have read part I of this II part series first!

Cold weather injuries can occur even if temperatures are above freezing.  Some of the more common are Chilblains, frostbite and trench foot


Chilblains is a common cold related injury.  It may develop several hours after exposure to the cold.  They are painful, itchy, red to purple areas of swelling usually affecting the fingers, toes, nose and ears; but can be seen on other areas of the body.  Occasionally blisters and small sores will be seen in some individuals but not always.  These lesions can take several weeks to heal and the area can remain sensitive to cold.  If found, cover the area with a dry sterile dressing and address re-warming the patient.

Frostbite is the freezing of tissues involved.  It is graded similar to a burn, 1st through 3rd degrees.

  • 1st degree is an irritation to the skin.  A superficial paleness to the skin and cold to touch.
  • 2nd degree forms blisters and involves deeper tissues however usually does not involve major damage.
  • 3rd degree involves all layers of the skin, full thickness, and results in permanent damage and potentially amputation.

Diagnosis / Symptoms

Frostbite is evident by pale, hard, cold skin that is sensitive to touch usually with aching pain.  As it thaws the area becomes very painful and reddened.  Severe cases may remain a purplish black color.

Patients that take beta-blockers are at greater risk because of decreased blood flow to the skin, as are people with peripheral vascular disease.  Smokers should also be placed in this group due to the vasoconstricting affects of nicotine.

Initially the sensation of pins and needles is common followed by numbness and possibly an aching sensation.  Later sensation decreases and stiffness increases leading to loss of both sensation and movement.


Shelter is a priority in the treatment of cold weather injuries.  If immediate access to a hospital is available it is best to wrap the affected areas in dry sterile dressings, separating fingers and toes, and transport the person to an appropriate facility.

If immediate hospital care is not readily available the affected extremities can be soaked in warm (104-108 degree F) water for 20-30 minutes.  During the re-warming process severe pain and swelling are probable.  Do not thaw the affected areas if re-freezing is a possibility.  It is far more damaging to allow the tissues to thaw and refreeze than to leave them frozen.  Once thawed wrap the areas as above while moving them as little as possible.  If there is extensive damage warm fluids can be given to replace any lost fluids.  Accomplish transport to the hospital as quickly as possible.

Prevention and Considerations

The best prevention is good planning.  Much like hypothermia frostbite can be avoided or at least minimized through good protective gear and awareness of your surroundings.

With cold related injuries one most also be aware of the effects that it will have on all of your systems.  One of the biggest considerations is the return of cold fluids to the core.  If this happens the already taxed system is at risk for life threatening reactions, including shock and lethal arrhythmias.  Therefore take the time to assess your whole patient and address their unique situation accordingly.

Reminder; Treatment of injuries must be in accordance with department and EMS policy.

Article by Alan Ramsay, a Career Firefighter, Paramedic and RN

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