³ Treating for Cold Exposure and Frostbite ³
The following material may assist you in treating a victim for
exposure to the cold and also how to deal with frostbite. This
information is derived from "Advanced First Aid & Emergency Care,"
2nd edition, by the American Red Cross. To obtain a copy of this
book and to take instruction in first aid, please contact the local
office of the American Red Cross. They are listed in the white
pages of your telephone book.
The extent of injury caused by exposure to abnormally low
temperature generally depends on such factors as wind velocity,
type and duration of exposure, temperature and humidity.
Freezing is accelerated by wind, humidity or a combination of
the two. Injury caused by cold, dry air will be less than that
caused by cold, moist air or exposure to cold air while wearing wet
clothing. Fatigue, smoking, drinking of alcoholic beverages,
emotional stress and the presence of wounds or fractures intensity
the harmful effects of cold.
SIGNS AND SYMPTOMS
The general manifestations of prolonged exposure to extreme
cold include shivering, numbness, low body temperature, drowsiness
and marked muscular weakness. As time passes there is mental
confusion and impairment of judgment. The victim staggers, his
eyesight fails, he falls and he may become unconscious. Shock is
evident and the victim's heart may develop fibrillation. Death, if
it occurs, is usually due to heart failure.
Frostbite results when crystals form, either superficially or
deeply in the fluids and the underlying soft tissues of the skin.
The effects are more severe if the injured area is thawed and then
refrozen. Frostbite is the most common injury caused by exposure to
the cold elements. Usually, the frozen area is small. the nose,
cheeks, ears, fingers and toes are the most commonly affected.
Just before frostbite occurs, the affected skin may be slight-
ly flushed. The skin changes to white or grayish yellow as the
frostbite develops. Pain is sometimes felt early but subsides
later. Often there is NO pain; the part being frostbitten simply
feels intensely cold and numb. The victim commonly is not aware of
frostbite until someone tells him or until he observes his pale,
glossy skin. The extent of local injury cannot be determined
accurately on initial examination, even after rewarming. The extent
of tissue damage usually corresponds to that in burns. In superfi-
cial frostbite, there will be an area that looks white or grayish
and the surface skin will feel hard but the underlying tissue will
be soft. With deeper involvement, large blisters appear on the
surface, as well as in underlying tissue, and the affected area is
hard, cold and insensitive. Destruction of the entire thickness of
the skin will necessitate skin grafting and will constitute a
medical emergency, because gangrene may result from loss of blood
supply to the injured part.
The objectives of first aid are to protect the frozen area
from further injury, to warm the affected part rapidly and to
maintain respiration. Formerly, it was recommended that victims of
frostbite be treated by slow warming -- rubbing with snow and
gradually increasing the temperature. But recent studies have shown
conclusively that much better results are obtained if the affected
part is WARMED RAPIDLY in running or circulating water, unless the
part has been thawed and refrozen, in which case it should be
warmed at room temperature (from 70 to 74 degrees Fahrenheit). Do
NOT use excessive heat, as from a stove, hot water bottles, elec-
tric blankets or other devices.
1. Cover the frozen part.
2. Provide extra clothing and blankets.
3. Bring the victim indoors as soon as possible.
4. Give him a warm drink (not alcoholic!).
5. Rewarm the frozen part QUICKLY by immersing it in water that
is warm but not hot. Test the water by pouring some over the
inner surface of your forearm or place a thermometer in the
water and carefully add warm water to keep the temperature
between 102 degrees and 105 degrees Fahrenheit. If warm water
is not available or practical to use, wrap the affected part
in a sheet and warm blankets.
6. Handle the area of the frostbite GENTLY and DO NOT MASSAGE IT.
Severe swelling will develop rapidly after thawing. Discon-
tinue warming as soon as the part becomes flushed (turning
red). Once the part is rewarmed, have the victim exercise it.
7. Cleanse the affected area with water and either soap or a mild
detergent (NOT laundry or dishwasher detergent, though; they
can be caustic and cause a chemical burn). Rinse it thorough-
ly. Carefully blot dry with sterile or clean towels. Do NOT
break the blisters.
8. If the victim's fingers or toes are involved, place dry,
sterile gauze between them to keep them separated.
9. Do NOT apply other dressings unless the victim is to be
transported to medical aid.
10. Elevate frostbitten parts and protect them from contact with
11. Do NOT allow the victim to walk after the affected part thaws,
if his feet are involved.
12. Do not apply additional heat and do not allow the victim to
sit near a radiator, stove or fire. The numbed part may be
severely burned and the victim might never realize it is
happening to him.
13. If a person with frozen feet is alone and MUST walk to get
medical assistance, he should NOT attempt thawing in advance.
14. If travel after receiving first aid is necessary, cover the
affected parts with a sterile or clean cloth.
15. Obtain medical assistance as soon as possible. If the distance
to be covered is great, apply temporary dressings to the hands
if they have been affected by frostbite.
16. Keep injured parts elevated during transportation.
17. If medical help or trained ambulance personnel will not reach
the scene for an hour or more AND if the victim is CONSCIOUS
and NOT VOMITING, give him a weak solution of salt and baking
soda at home or while enroute (1 level teaspoon of salt and
1/2 level teaspoon of baking soda in each quart of water,
neither hot nor cold). Do not give alcoholic beverages. Allow
the victim to sip S-L-O-W-L-Y. Give an adult about 4 ounces (a
half glass) over a period of 15 minutes; give a child from 1
to 12 years old about 2 ounces; give an infant (under 1 year
old) about 1 ounce every 15 minutes. Discontinue giving fluids
if vomiting occurs. Fluid may be given by mouth ONLY if
medical help will not be available for an hour or more and is
not otherwise contraindicated.
1. Give the victim artificial respiration, if necessary.
2. Bring the victim into a warm room as quickly as possible.
3. Remove wet or frozen clothing and anything that constricts the
victim's arms, legs or fingers and might interfere with
circulation as the frozen part is thawed and swelling begins.
4. Rewarm the victim rapidly by wrapping him in a warm blanket or
by placing him in a tub of water that is warmed to 102 to 105
degrees Fahrenheit. If a thermometer is not available, make
sure the water is not hot to YOUR hand and forearm.
5. If the victim is conscious, give him hot liquids (but not
alcohol) by mouth.
6. Dry the victim thoroughly if water was used to rewarm him.
7. Carry out the appropriate procedures as described under frost-