Sorry, folks. It’s that time of year when thoughts turn to the soft peace of falling snow, the beautiful glitter of the sun emerging after an ice-storm … and frostbite. What to do if something bad goes down on some frigid night and someone you care about gets some freezing body parts, with no medical professionals to be found? Well, I’m not a physician either, but here I summarize for you the prepper-relevant points that the Wilderness Medical Society came up with*.
To be clear, we’re not talking here about hypothermia, when your core body temperature drops too far. (A piece on that will be coming up later.) . Nor are we talking garden variety cold, numb fingers or toes, even if there’s surface frost on the skin. (This is called ‘frost-nip’ and needs no treatment beyond the obvious ‘warm it up’.) . This is about full-on frost-bite, where skin and maybe even deeper tissue is frozen solid.
Don’t be this guy. Thanks Thomas Cook *** for the image.
Don’t go there.
You probably won’t be shocked when I recommend against getting frostbite in the first place. The article also had some suggestions on this point that are worth passing along. Of course you know to cover exposed skin and keep dry; but did you realize that keeping yourself well hydrated in general helps protect you? Your nice warm blood flows better through those freeze-prone extremities when there’s enough water in the blood.
That blood flow is important, so don’t force that extra pair of socks on if it will make the boots so tight it impairs blood flow. Much as I love warm socks, that’s a poor trade. Those chemical hand and foot warmers are good too; but before activating them you should put them in an inside pocket to get them close to body temperature. It helps the chemical reactions start so you get good heating.
Bad ideas
It’s also worth tossing out a couple of common old-wives tales. These wives must be from Florida or something, they don’t know frost-bite. Putting oils, waxes, petroleum jelly, or similar on the hands or feet has been rumored to reduce freezing. Doesn’t work. Also, please, Please don’t ever rub snow on a frozen part! I can’t even imagine where that one came from, but I’ve been hearing that really dumb idea since I was old enough to go sledding.
When to start the thaw
Don’t try to thaw out frozen parts if you aren’t sure you’ll be able to keep them thawed and warm for the foreseeable future. Thawing out some fingers or toes just so they can refreeze as soon as you start walking again multiplies the damage. Just leave it alone. If the person’s normal blood flow causes the parts to thaw, it’ll do more harm than good to try to stop that; but don’t actually try to thaw until you can make it stick.
In the meantime, you can start feeding the snow-man ibuprofen, 12 mg/kg per day divided into two doses. That comes out to a bit over 800 mg doses every 12 hr for a 150 lb person. If they’re hurting, you can give up to 2400 mg/day, according to the guidelines. Aspirin is another decent option. These drugs, throughout the whole process including thawing and recovery are not just about pain control. They also block the production of some really unhelpful chemical signals the person’s immune system will start trying to produce. These chemical signals cause a lot of tissue damage.
In any case, remove any jewelry or other items from the frozen area. If the person must use the frozen part, pad, splint, or otherwise immobilize it as much as possible to reduce damage.
How to accomplish the thawing
The Wilderness Med Society says you should thaw the parts once you have the means to keep them thawed if you’re more than two hours from real medical help. If you’re closer than that, let the pros handle it.
The best way is to use a warm water bath. You want its temp to be around 99 – 102 F. If you don’t have a thermometer, someone should leave her unfrozen hand in the water for at least 30 sec to make sure it’s not too hot. The frozen limb won’t feel the heat, but will cook all the same. People make terrible baked Alaska (feel free to google that wonderful stuff if you’re not familiar with it).
Don’t use ovens, space heaters, or other high-heat implements if you can’t get the water bath. They carry too much risk of burns. Instead, let someone’s body heat thaw the part gradually. Sticking someone’s frozen toes in your armpit is not glamorous, but it will be effective. And you won’t be sleepy!
Don’t let the skin touch the sides of a metal pot, if that’s your water bath. Do keep the water moving and keep it warm; and keep checking it’s temperature. The bath takes very roughly 30 min to work, more or less depending on severity of the freeze. You’re done when the part is red or purple and soft again. Feel free to feed the patient painkillers during the thaw; either NSAID drugs such as over the counter pain remedies, or opiates if you’ve got them. Being thawed is not fun.
Once the part is soft again, let it air dry or blot it gently. No rubbing! There may be blisters; filled with clear fluid for less serious freezes and blood for deeper injuries. Don’t mess with the blisters unless it looks like they’re so tense they’ll rip open on their own. If that’s the case, you can drain them with a needle. Leave the skin over them and work clean; you don’t want microbes getting in there.
If there are blisters, leave them be if possible, or drain with a needle if they threaten to rupture. Thanks Dr. S. Falz**
If you have some aloe vera (commercial product or juice/gel), you can put some on before you bandage. There’s some evidence it can help calm the immune response, just as the ibuprofen is doing.
Apply bulky, dry gauze dressings. Make them loose; swelling is expected and you don’t want to cause a lot of compression.
Keeping the thawed part above the level of the heart is recommended. That will reduce swelling, for one thing.
Can the person walk on a thawed foot? It’s best not to, but if it’s just the toes, it’s possible. Putting a lot of weight on the thawed part will cause extra tissue damage though. If the person must walk with the injury, get the boots back on before the feet swell too badly then leave them on. The boot will limit the swelling. If you wait too long, the boot will not go back on the foot, whether you ‘need’ it to or not.
Long term recovery
We’ve all heard that sometimes frostbite necessitates amputations. Well, that’s Way beyond what I can reasonably talk about; except to point out that according to the article, you can’t know how much tissue will recover for more than a month. They suggested repeating the warm water bath routine once or twice a day for weeks after the injury; and also keeping up the ibuprofen.
There you have it. Thankfully, I haven’t any personal experience with this topic; but I was impressed with the clarity and practicality of the source, so I have high hopes that the advice will serve us well should any of us need it. But let’s not!
* McIntosh, Scott E. et al. (2011) Wilderness Medical Society Practice Guidelines for the Prevention and Treatment of Frostbite. Wilderness & Environmental Medicine , Volume 22 , Issue 2 , 156 – 166. http://www.wemjournal.org/article/S1080-6032(11)00077-9/fulltext
** By Dr. S. Falz (From here phone) [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons
*** By Thomas Cook (DSC_7272) [CC BY-SA 2.0 (https://creativecommons.org/licenses/by-sa/2.0)], via Wikimedia Commons