Outdoor enjoyment doesn't have to end just because the weather turns cold. But winter does mean taking a few extra precautions. The two leading causes of cold injury, hypothermia and frostbite, can have serious consequences - even death. But they are both preventable and treatable.
The Hypothermia Hazard
When the body's core temperature drops below 98.6, a condition known as hypothermia exists. Core temperature is the temperature of internal organs, particularly the heart, lungs, and brain. Mild hypothermia can occur even in warm weather, particularly in elderly people or people with circulation problems. In weather as warm as 60°, enough wind and rain can make hypothermia a real possibility for anyone. Other contributing factors are inappropriate clothing, wetness, fatigue or exhaustaion, dehydration, poor food intake and alcohol intake.
Signs of Hypothermia
"The Umbles:" The victim stumbles, mumbles, fumbles and grumbles, showing loss of coordination and mental alertness.
Mild hypothermia (core temperature 98.6° - 96°F)
- Shivering - not under voluntary control
- Can't do complex functions (like skiing), but can still walk & talk
Moderate hypothermia (core temperature 95° - 93°F)
- Dazed consciousness
- Loss of coordination in hands
- Slurred speech
- Violent shivering
- Irrational behavior
- "I don't care" attitude
Severe hypothermia (core temperature 92° - 86°F)
- Shivering occurs in waves - pauses between episodes becomes longer until shivering ceases
- Victim can't walk; curls up on ground in fetal position Muscle rigidity
- Pale skin
- Dilated pupils
- Reduced breathing and heart rate
Treating Mild and Moderate Hypothermia
Conserve the heat the victim already has and replace the body fuel they have spent trying to keep warm. Reduce heat loss by adding layers of clothing, replacting wet clothing, increasing physical activity and finding shelter from cold/wet weather.
Add Fuel and fluids, including carbohydrates (warm sugar water or liquid Jello™ for heat and quick energy), protein (protein bars for slower-burning fuel), fats (even longer-burning, but require more energy and water to break down). Granola trail mix (GORP) is a source of carbohydrates, proteins and fats. Avoid alcohol, caffeine and tobacco.
Treating Severe Hypothermia
Wrap patient in multiple layers of wool blankets or sleeping bags, with a final layer of plastic sheeting to protect from moisture. Feed patient only warm sugar water every 15 minutes. Diluted (not full-strength) liquid Jello™ works best because of its protein content. Help patient urinate. Heat is lost to a full bladder, so urination will help conserve heat.
Add heat. Hot water bottles, heat packs - even warm rocks or towels - can be applied to major arteries - neck (carotid), armpits (brachial), groin (femoral), and palms of hands (arterial arch).
Rescue breathing can increase oxygen and provide internal heat. Watch out for "Afterdrop," where the core temperature decreases during re-warming. This dangerous effect happens as the result of the skin layer warming too fast, sending cold stagnant blood from the surface to the internal organs. Avoid afterdrop by re-warming the core only. Do not expose a severely hypothermic patient to extremes of heat.
Frostbite is the actual freezing of body tissue. When this happens cells rupture due to increased water or from tearing by ice crystals. That's why you should never rub frostbitten skin. Like hypothermia, there are degrees of frostbite.
Before frostbite begins, a condition known as Cold Response occurs, where the area may be painful, may be pale or red, is resilient but cold to the touch. In Mild Frostbite, skin may have sensation, but appears white and waxy. The top layers of skin have begun to freeze and feel hard, but deeper tissue is still soft. It usually occurs on cheeks, earlobes, fingers and toes. Damage is usually reversible.
Treatment for Cold Response and Mild Frostbite is simple: Rewarm gently. Blowing warm air or placing the area against a warm body part is usually sufficient. Do not rub the area!
Frostbite is more serious and can cause permanent damage. You should seek medical attention as soon as possible. In frostbite, the skin is white, feels "wooden" and numb, or has no sensation at all. If only a small area is frostbitten, it can be rewarmed as frostnip.
Deeper frostbite requires special care, as muscle and bone may be at risk.
Prevention of cold injuries is simple:
- Dress appropriately. Add or subtract layers as activities and weather conditions apply.
- Don't stay in wet clothing. Stop and change as soon as possible..
- Avoid alcohol, tobacco and caffeine, as these can adversely affect the body's natural ability to control heat loss.
- Use the Buddy System to check on each other's faces, cheeks and ears for signs of frostbite.
- When you do find evidence of cold injury, stop and rewarm the area.
- Don't become overtired. When you feel fatigued, find a warm place to rest.
- Eat well. Your body needs extra fuel to keep warm.