Tips For Frostbite Prevention And Treatment

By Lisa Cooke

As fall turns into winter months and then into those ever unpredictable spring months our skin and bodies may be exposed to cold temperatures, particularly when working at outdoor rinks.  As managers, skating directors and coaches we need to be diligent about not allowing our skin to be exposed during outside work related activities. 

Frostbite is the freezing of the skin and/or other tissues of the body.  Hands, fingers, feet, nose, ears and face are the most commonly affected areas.  Frostbite can cause severe damage to deep structures such as muscles, tendons, nerves, and bone when left untreated. 

When the body is exposed to very low temperatures, wind, and water, all of which are exacerbated at altitude, it redirects blood flow away from the extremities to the body’s core. This is a natural reaction to prevent body heat loss and hypothermia.  Ice or ice crystals may then form in and around the skin cells.  These crystals can block capillary blood flow resulting in the loss of oxygen and nutrients. Also, sudden warming can cause the cells to rupture. This is evident when large blisters form which is caused by superficial or severe frostbite. The longer the tissue is frozen, the greater the potential for damage.

Frostbite can occur in as little as thirty-seconds in extreme conditions. Factors such as wind chill, alcohol consumption, altitude, getting wet or damp and how long you are exposed to the cold can all have an impact how quickly and how severe frostbite can be. In the case of your feet, long term exposure to moderate cold and wet boots can and does cause a more serious injury than short-term exposure to severe cold. It is a complex equation that needs to be weighed careful when outdoors in the cold, altitude and when getting wet as in the case of working with Zambonis or on outdoor rinks/ponds.

Frostbite is divided into three sets of categories:
1st degree or Frostnip – is numbed skin, white or pale appearance of the skin is likely. Most people who live in a cold climate or those of us doing outdoor activity in the winter have had first degree frostbite (just as most of us have had a first degree burn when we get sun burnt). Skin may feel stiff to the touch but the tissues underneath will be warm and soft. As long as frostnip is treated properly there is little chance of blistering, infection or permanent scarring.
2nd degree or Superficial Frostbite – the outer layer of skin feels hard and frozen and will be white or blue in color. The skin will likely form blisters, which can vary in size. This is a serious medical condition that needs to be treated by a trained medical professional. The tissue underneath is still undamaged. Proper and immediate treatment is critical to prevent severe or permanent injuries.
3rd degree or Deep Frostbite – the underlying tissues become hard and frozen; skin appears blotchy, waxy, and white, grayish-yellow or black in color; tissue feels “wooden.” This is a life threatening injury and must be taken seriously. Deep frostbite needs to be treated by a trained medical professional. The tissue underneath has been damaged; in severe cases amputation may be the final recourse to prevent severe infection. Blistering will happen and can be severe. Proper medical treatment in a medical facility with personnel trained to deal with severe frostbite injuries is required.

Prevention of Frostbite:
Before going out in cold temperatures you should:
Try to have all of your skin covered during low temperatures, wear warm, and dry clothing. Try to stay out of the wind as much as possible. Cover your face when ever possible.
Before going outside in cold temperatures apply lotion[s] and Chap Stick to lips to keep skin protected. The face, hands and any other exposed body part are key areas to apply the lotion on.
Dress properly for the conditions, wearing mittens whenever possible helps keep fingers together and their collective body heat keeps the hands warmer.
Check skin frequently for signs of frostbite (use the buddy system)
Take frequent “warm-up” breaks, go inside often based on the current conditions; remember that fatigue and lack of oxygen in high elevations, and the consumption of alcohol may cause you to ignore any discomfort and cold you or guests would otherwise experience.
Stay hydrated; avoid drinks with caffeine and alcohol. Alcohol interferes with the body’s ability to regulate temperature.
Avoid tobacco as it decreases circulation.
Eat warm, high-calorie foods.
Avoid exhaustion or fatigue.
Be sure clothing is non-restrictive and allowing blood to circulate (especially gloves). Use multiple layers when in cold weather and change any wet clothing as soon as possible.
Be extremely cautious in the wind.  Wind/altitude adds to the exposure of cold temperatures.

Treatment of Frostbite
At the first signs of frostbite, come out of the cold and remove any wet clothing and replace with dry clothing if available. Get the affected area rewarmed as rapidly as possible.

Do not rub the skin as this causes friction and can destroy the damaged skin and underlying tissues. This may/can also increase the risk of infection.

Wrapping the affected area with sterile gauze is beneficial, especially between affected fingers and toes if possible to decrease rubbing of the area. If gauze is not available any dry material is advised such as bandages and warm clothing.

Elevate the affected area and seek medical attention promptly as the rewarming process is a painful procedure although it has proven to be an important treatment. Some people believe that the rewarming process should only be done in an emergency room/department.

If there is any chance of refreezing a thawed body part, do not rewarm it in the first place as this causes much more damage than being frozen just once.

The above information came from the following sites:

http://www.outdoorplaces.com/Features/Mountain/frostbite/frostbite.html

http://www.healthscout.com/ency/68/453/main.html