While we are currently getting a break from the cold, frigid temperatures of winter, we still have a long way to go before spring makes its appearance. In light of just how cold it has been recently, it seemed like a good time to review the signs and symptoms of frostbite and hypothermia and how to protect against them, as well as those who are at the greatest risk.
In my career as a hand therapist, I have treated a patient in the aftermath of experiencing both. It is a case I will never forget. My patient was an elderly man who lived alone in a first floor tenement apartment. He fell in his driveway on a particularly frigid evening; temperatures were in the single digits with snow and ice on the ground. He was not wearing a coat or gloves; he had gone out quickly to take out his trash. There was no railing at his back door he could use to help himself up so he crawled around his house to the front door. In that short period of time exposed to the elements, he ended up with hypothermia and a case of frostbite so significant he had to have multiple fingertips amputated.
Living in New England, most of us know the importance of dressing appropriately for the weather. Clearly that is the most important way to prevent frostbite and hypothermia. Dressing in layers is pivotal. When you dress in layers the heat from your body gets trapped inside your clothes. This keeps your body’s core temperature (the temperature in your trunk where your vital organs are) above 95°. The colder it is and the longer you are going to be exposed to the cold, the more layers you need. A minimum of 3 layers when the temperatures are at freezing (32°fahrenheit) level is the recommendation. It is important when you’re wearing layers to take them off as you warm up and add them back if you cool down. If you wear too much and are too warm you will sweat and this will make you even colder.
Because of this, it is also recommended that if you are doing any exercise or exertional activities such as shoveling snow or skiing outside in the cold, your inner layer is made of a material that will wick away the sweat from your body. The outer layer of clothing needs to be waterproof and windproof, this is true for anyone out in the cold. Rain, sleet, snow and wind only amplify cold weathers effect on the body. Protecting your hands, feet, neck, and face is just as important: a warm hat, face mask, scarf or neck warmer, mittens or gloves, wool socks and warm waterproof shoes or boots protect against frostbite.
If your core temperature drops below 95° you will start to experience the early symptoms of hypothermia and frostbite. Even a mild case of hypothermia can affect your mental and physical abilities. It can dramatically affect a person’s ability to think clearly and get help. In the case of my patient once he got into his house he laid down on his couch and instead of calling 911 for help, fell asleep. Being aware of and watching for the early signs of hypothermia and frostbite (the early signs are called frost nip) when you are exposed to the cold for extended periods of time is vital. The early stages of frostbite include: Red and cold skin; skin can start to turn white or waxy looking but is still soft to the touch, sensations of prickling, numbness, tingling and/or stinging in the affected skin areas. In the early phases of hypothermia a person will feel cold, shiver and begin to develop a case of the “umbles” stumbles, bumbles, grumbles, and mumbles, or to be more specific mental confusion, incoordination and slurred speech and fatigue. These behaviors are a clear sign that cold has started to affect the individual’s body and brain.
The elderly and small infants are at a greater risk of developing hypothermia and frostbite than the general population. Certain medical comorbidities also affect the body’s ability to self-regulate temperature and can put you at a greater risk for developing hypothermia or frostbite. Examples are an underactive thyroid (hypothyroidism), poor nutrition or anorexia nervosa, diabetes, stroke, severe arthritis, Parkinson's disease, trauma, and spinal cord injuries. Certain medications also do the same thing and increase the risk. Alcohol and drug use significantly increase the risk of hypothermia and frostbite as well as certain forms of mental illness.
If you notice any of these symptoms in yourself or others it is important to take action immediately. Obviously the first thing to do if possible is to get out of the cold. If that is not possible, add more layers of clothing, drink fluids or try eating carbohydrates and move around to warm up your core; running in place or flapping your arms, etc. Attempt to warm up any areas of skin exhibiting the early signs of frostbite with indirect heat, but do not rub them or place heat directly on them, instead put your hands in your arm pits for example or pull your scarf up to cover your nose. If this doesn’t work or causes more pain seek medical attention immediately. True frostbite needs medical attention. Rewarming frostbitten tissue can be extremely painful and cause even more damage if not done properly. If someone is exhibiting the signs of hypothermia they need medical attention immediately. Remember, hypothermia and frostbite are preventable -- if the temperature is below freezing (0°C), consider yourself at risk and take the proper precautions.