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How to Prevent and Treat Frostbite



By Kim Hayes, AARP, January 2024


Learn your risk factors to protect you, your pets, and your family. A majority of states have plunged into frigid temperatures as a deep freeze and serious winter storms hit. As record-setting cold snaps affect millions, it is more important than ever to be aware and prepared for the possibility of frostbite. It is especially crucial to look out for older family members. ​​Older people are more at risk for frostbite, says Dawn Marie Davis, a dermatologist with the Mayo Clinic in Rochester, Minnesota.


“When you are older, your tissues are weakened and they don’t heal as well,” she says. Older people are also more likely to have blood vessel diseases, which make people more susceptible to frostbite.​ ​Frostbite is a bodily injury caused by exposure to extremely cold temperatures, according to the Centers for Disease Control and Prevention (CDC). Freezing temps can result in loss of feeling and color in affected areas of your body — most often your extremities. Frostbite can permanently damage your body, and in severe cases, it may lead to amputation.​


Davis says frostbite can happen in a matter of minutes, depending on conditions. Other than cold temperatures and the amount of clothes you have on, wind and altitude can also make frostbite more likely. A damp, wet type of cold or having wet clothes also increases risk. People can get frostbite under clothes as well as on exposed skin.​​


Risk factors


Risks for developing frostbite include:​ 

  • Having poor blood circulation​

  • Not dressing properly for extremely low temperatures (Alzheimer’s and other dementia patients may need extra guidance on how to dress appropriately, and older people in general may not have access to proper food, clothing or heating.)​

  • Staying outdoors for long periods (homeless people, hikers, hunters, etc.)​

  • Drinking alcohol in excess or using illicit drugs

  • Taking medication for high blood pressure

  • Having diabetes

  • Having peripheral artery disease (PAD) 

  • Smoking


Prevention

​Try to stay indoors as much as possible when the weather is extremely cold. If you must go outside, dress properly, and make sure that loved ones at high risk are also dressed appropriately. As the Swedish saying goes, “There is no bad weather, only bad clothes.”​

When going outside in cold temperatures, be sure to wear:​ 

  • A scarf or knit mask that covers your face and mouth​

  • Mittens or gloves​

  • Water-resistant boots​

  • A hat​

  • A water-resistant coat​

  • Several layers of loose-fitting clothing​

Make sure that the body parts most often hit by frostbite are covered in warm, dry clothing: nose, ears, toes, cheeks, chin and fingers.


Three stages of frostbite

Frostbite can occur in several stages, according to the Mayo Clinic.

1. Frostnip

Frostnip is a mild form of frostbite and leads to numbness. As the skin warms, it can be painful, but it doesn’t cause permanent skin damage. 


2. Superficial frostbite

This causes slight changes in skin color and the skin may start to feel warm, which is a sign of trouble. This level can be painful, Davis says. “The tissue starts to freeze, nerves and the blood vessels react.” If you treat frostbite by rewarming the affected area at this stage, you may notice stinging, burning and swelling. “There is pain as the tissue is flooded with more blood,” Davis says. A blister may appear 12 to 36 hours after rewarming.


3. Deep, severe frostbite

As frostbite becomes worse, it affects more than the outer layer of skin. “If the cold exposure is drastic enough, it can go beyond the superficial layers to the deeper tissue which would include nerves and supportive tissue,” Davis says. The skin turns white or blue-gray and you no longer feel sensations of cold or discomfort. Blisters form 24 to 48 hours after warming, and the skin turns black and hard as it dies. “If you aren’t able to compensate, the next stage is painless and the damage is extreme,” Davis says. 


At the first signs of redness or pain on your skin, the CDC advises getting out of the cold and protecting any exposed skin, as this could be the early stages of frostbite. Other indicators include:​

  • A white or grayish-yellow skin area​

  • Skin that feels unusually firm or waxy​

  • Numbness​ 

It may be difficult to detect frostbite on yourself because the frozen tissue on your skin is numb. So pay attention if someone else says that you display warning signs, and be sure to look out for your loved ones as well.


Treatment


Seek medical care if you detect symptoms of frostbite, the CDC says. It is also important to first determine whether the victim is showing signs of hypothermia, which is a more serious medical condition caused by prolonged exposure to cold weather and requires emergency medical assistance.​Davis says frostbite heals the way other wounds heal, but if the frostbite is too severe, people need treatment from a doctor.

DO

​If there are no signs of hypothermia and immediate medical care is not available, the CDC recommends the following steps to treat frostbite:​​

  • Get into a warm room, and remove wet clothing.​

  • Immerse the affected area in warm but not hot water. (Keep the temperature at a comfortable level for unaffected parts of the body.)​

  • Warm the frostbitten area using body heat, for example inserting frostbitten fingers in your armpit.​

  • Stay warm under blankets and layers of dry clothing.​ 

DO NOT


  • Walk on frostbitten feet or toes unless absolutely necessary; this increases the damage.​

  • Rub the frostbitten skin with snow or massage it — you may cause more damage.​

  • Use artificial heat sources such as a heating pad, heat lamp, stove, fireplace or radiators. The affected areas of your skin are numb and could be easily burned, according to the CDC. ​It is important to remember that home remedies are not substitutes for proper medical care. Frostbite should be evaluated by a health care provider, and hypothermia should be treated as a medical emergency. ​​

Be prepared

The CDC recommends taking a first aid and emergency resuscitation course to prepare for cold weather health problems and preparing your home and car for winter emergencies. “Oftentimes it’s people who get stuck in the snow” who get frostbite, Davis says. 

She says to be especially careful of loved ones who have dementia. “Someone might have Alzheimer’s disease and sundowns and wanders outside,” she says. “They might not be dressed for the cold weather and they can be unaware that they are in danger.” Children playing in the snow, those experiencing homelessness and people who work outdoors, such as in construction, are also at risk. 

“Usually it’s accidental, so it’s about public health awareness,” Davis says.


Keeping pets safe in extreme cold


People often think pets are less susceptible to cold because of their fur, but that’s not true, according to the American Veterinary Medical Association. Here are some tips for keeping your pets healthy in frigid weather. 


1. Know your pet: Cold tolerance varies for pets based on their health, coat, body fat and activity level. Older dogs, like older humans, can be more susceptible to the cold. “Older dogs and dogs with metabolic issues cannot regulate their temperature as well, so they are more prone to problems than young and healthy dogs,” says Caroline Cervelli, a veterinarian with the Breckenridge Animal Clinic in Breckenridge, Colorado. She says that although frostbite is not common in dogs, it can occur even at temperatures above freezing and if an animal is wet. Paws, tails, noses and ears are the areas most prone to frostbite. She recommends limiting time outdoors for senior dogs and short-coated breeds.


2. Check those paws: Check your dog’s paws frequently for cracks or bleeding, which are signs of cold-weather damage. Dogs that are walking or running in snow will stop to chew on snowballs in their paws due to pain or discomfort, Cervelli says. Trimming the hair between dogs’ digits can help avoid snowball buildup, though Cervelli cautions that owners should use clippers, never scissors, to do this, unless they are experienced in grooming. “The severity of snowballs can depend on the type of snow and temperatures,” she says.


3. Sweater weather: If your dog has a short coat or seems to be affected by the cold, consider having it wear a sweater and keeping several on hand. “Sweaters and boots are a great idea for short-coated breeds and very small dogs,” Cervelli says. Make sure the sweater is dry, because a wet one can actually make the animal colder. You can also use booties to protect dogs’ paws, but make sure they fit properly. Cervelli says northern breeds, such as huskies, malamutes, chow chows and akitas, generally do not need sweaters because they have a thick undercoat that helps insulate them, but even the northern breeds can get frostbite in certain conditions.  


4. Wipe their paws: Deicers, antifreeze and other chemicals can be toxic. Wipe down pets’ paws when they come home to protect them from poisoning when they lick their paws. Consider using pet-friendly deicers.



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