Cold-Weather Health Emergencies

Be prepared to treat people afflicted by frostbite, hypothermia, and other conditions brought on by extreme low temperature.

By Randall Davis, F471978
January/February 2025

In many parts of North America, winter brings frigid weather, and with it the possibility of cold-related injuries. Frostbite can affect specific body parts, and hypothermia can cause systemic injury to the body (hypo = less or too little, and thermia = temperature). In both cases, cold, wind, and wetness can lead to medical emergencies. All cold-related injuries have various stages of severity.

FROSTBITE

Cold environments, cold gases, or touching cold surfaces can impact exposed skin anywhere on the body. In fact, most of us have experienced mild frostbite — when an exposed body part becomes cold and begins to tingle. We must get out of the cold and warm the exposed part. If the exposed parts are hands or fingers, one method of doing so is to place them under our armpits! Slow warming, NOT hot warming, is the key in all cases. Sometimes, simply exposing the cold parts to a warm environment does the trick.

Moderate frostbite is characterized by burning or pain in the exposed body part. Get out of the cold and begin slow warming in tepid (not hot) water. If that is not possible, then begin slow warming under armpits or by placing the affected part in a warm person’s hands until a better means of warmth can be obtained.

Severe frostbite occurs when sensation in the body part is lost. This is a true medical emergency, and the affected body part probably will not be able to be saved. The water in the exposed tissue has frozen, making the skin hard and cold. The skin may also appear waxen or even slightly blue. The worst thing to do is to massage the frozen body part; this will cause increased injury to the tissue from the ice crystals that have formed. The victim needs to be transported to a hospital by ambulance if possible. If medical help is unavailable, very slow warming (again, not hot) should be started. NEVER pack a frozen body part in snow. This is a very bad folk remedy.

HYPOTHERMIA

We have all experienced mild hypothermia as well. When we begin to shiver in the cold, this is hypothermia. Hypothermia occurs when the body temperature falls below 95 degrees Fahrenheit and can occur even in 50-degree weather if the body is wet and exposed to wind. When shivering begins, the victim should be moved from the cold environment to a warm environment. If the person is wet, remove their wet clothing, place blankets around them, and get them dry. Warm liquids can also be given. (Sorry, no hot toddies . . . alcohol is a no-no.)

Moderate hypothermia is characterized by uncontrollable shivering that won’t stop. The victim may have a change in personality or level of consciousness. Again, they should be removed from the cold environment and placed in warmth; be given warm liquids; and have their wet clothes replaced with dry ones or blankets.

With severe hypothermia, the victim may be very lethargic, agitated, combative, or unconscious. They stop shivering, so their body cannot produce heat. This is an extreme medical emergency that requires emergency medical service for pre-hospital care and hospitalization. Treat the patient very, very gently. Rough movement can precipitate a potentially lethal cardiac dysrhythmia (an abnormal or irregular heartbeat). Move them from the cold environment to a warm location. Begin slow warming and keep them dry. Be prepared to start CPR. If they are unconscious and breathing, place them on their side. Also place blankets on top of and underneath them. Avoid putting blankets on the patient without providing a source of heat under them, as you will just be insulating the patient from warm air. Because severe hypothermia victims cannot produce their own heat, you may have to place a warm person under the blankets with them to provide a heat source. Do not place anything next to the patient that will burn their skin.

You can keep heat packs and lightweight, reflective “space blankets” in your first-aid kit for cold-weather emergencies. If you use a heat pack, wrap it in a cloth if it is too hot.

PREVENTION AND AWARENESS

As I always point out, prevention is the best way to avoid an emergency. Dress appropriately for the temperature, and do not stay in a cold environment too long. Be sure to cover your head in cold weather; the greatest amount of heat loss is through your head. Dress in layers and stay dry.

Be aware that the elderly and the very young can be more susceptible to cold temperatures. Some medical conditions may be exacerbated by cold and could also increase health risks. Cold air can bring on an asthma attack, and cold environments can worsen conditions such as Parkinson’s, multiple sclerosis, lupus, and anemia. Raynaud’s disease, which affects the ability of arteries in fingers and toes to deliver blood, may make a victim more susceptible to cold, especially frostbite.

Medications can also affect your body’s ability to regulate temperature. Examples include levothyroxine for thyroid issues (a common brand is Synthroid), along with diuretics, antihypertensives, narcotics, and sedatives.

In summary, if a victim or a body part is too cold . . . warm ’em up!

Have a safe day!

Randall (Randy) J. Davis is a licensed paramedic and has provided emergency patient care for over 40 years. He has also managed the St. Louis Community College EMS training programs and retired from the St. Francois County (Missouri) Ambulance District as education coordinator. He is an EMS educator and has presented numerous basic and advanced life support classes for the American Heart Association and other nationally accredited emergency medical education programs.

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Source: https://familyrvingmag.com/2024/12/04/cold-weather-health-emergencies/