George R.R. Martin of A Game of Thrones said, “Nothing burns like the cold.” Truer words have never been spoken. Cold, like heat, can burn, just differently.

This time of year, as my fellow pre-hospital providers go forth to save lives, we should keep cold-related injuries such as frostbite top of mind. It’s important for providers to know some of the most common cold-related injuries and preventive measures we can take.

How do we lose heat or experience thermolysis? Conduction, convection, radiate and evaporation.

Much like heat-related emergencies, the body makes its own heat via the hypothalamus setting the basal metabolic rate. When in a cold environment, we lose heat faster than our body can make it, hence cold injuries can occur.

Since most cold injuries reside in the extremities, we can use a rhyming line up of fingers, nose, toes and hose to describe the most vulnerable parts of the human body.

Frost nip, the mildest form of injury, generally does’t cause pain and you’ll most commonly find it in people who spend too much time in the cold. A great example is people who participate in winter sports.Redness and numb extremities, primarily the fingers, nose and ears, characterize this injury.

An easy treatment is windmilling the arms, placing cold hands in your armpits or covering your ears with warm hands.

Risk factors for superficial and deep frostbite include:

  1. Inadequate clothing for the environment
  2. Impeding circulation with tight clothing, smoking or alcohol
  3. Fatigue, hunger or dehydration
  4. Coming in direct contact with cold objects

Superficial frostbite is characterized by alteration of sensations, white and waxy appearance with a firm-to-the-touch dermal area and a soft underlying tissue with palpation.

Deep frostbite has the firm-to-palpation dermal area of superficial frostbite but the underlying tissues are also firm to the touch. The skin is white to blue and all sensation is gone. This form of frostbite is most dangerous if you cannot guarantee a rapid re-warming.

If allowed to warm slowly, a partial refreezing may occur, which could cause ice crystals in cells to grow much larger and cause more damage than the initial freezing injury. Even with appropriate re-warming and care, cellular damage may be significant, and gangrene could set in.

Treatment does not differ between deep and superficial frostbite. Re-warming, pain control and dry sterile dressings for blisters are the general protocols. If refreezing worries you, leave the extremity cold and transport to a hospital.

Cold injuries not only occur in a patient lying in the street after a car accident and an elderly patient on a cold bathroom floor for hours, but to you, the pre-hospital professional when you leave for a shift ill prepared for your work environment.

When the temperatures drop, think healthy, stay hydrated, dress in layers and keep warm. Your health affects the patients you come in contact with every day.

Take our Individual CCTR-L11 course that includes hemorrhage control, trauma triage and pain management.