Frostbite - The Basics

• Frostbite is tissue injury involving the actual freezing of skin and subcutaneous (underlying) tissues. 

• Recovery from frostbite is slow, usually taking weeks or months. 

• Severe frostbite may lead to gangrene and necessitate amputation of the affected parts. 

• Once exposed, the patient will be predisposed toward frostbite in the future.

• Frostbite occurs when the body needs heat elsewhere and the body’s warming mechanisms fail; when your body is first exposed to the cold, it redirects blood flow from the extremities to protect internal organs.

• Capillary beds constrict; later they become damaged. 

• The blood thickens and becomes sludge like and circulation slows. 

• Ice crystals form in skin cells, drawing off moisture and dehydrating them. 

• The skin can’t get the oxygen, nutrients, and liquids it needs and can’t eliminate wastes, further damaging the tissue. 

• As exposure continues, your body’s core temperature begins to cool and your brain diverts blood from peripheral areas such as arms, legs, and ears, and sends them to your vital organs. 

• Freezing continues to happen and damage go deeper in the skin until the full thickness, including bone, freezes

Conditions Needed For Frostbite

The following conditions make frostbite more likely:

• Prolonged exposure to temperatures 32 degrees F (0 degrees C) or below

• Brief exposure to extremely low temperatures - minus 25 degrees F (-32 degrees C) and below

• Wind, humidity, rain, or snow (exposed flesh can freeze in 15 seconds at - 30 degrees F (-35 degrees C), with at 30 mph wind)

• Exposed body parts

• Restriction of circulation

• Fatigue, poor nutrition, poor liquid intake, and poor physical condition

• Previous case of frostbite or other cold injury

Causes Of Frost Bite

• Cold stress

• Low temperatures

• Wind chill

• Moisture

• Poor insulation

• Contact wit super cooled metal or gasoline

• Interference with circulation of blood

• Cramped position

• Tight clothing (wristwatches, etc.)

• Local pressure

• Tight fitting or laced boots

• Dehydration

Symptoms Of Frostbite

• The symptoms of frostbite vary with its severity. 

• First-degree frostbite, or frostnip, is the least severe form. 

• Second-degree frostbite is superficial and causes no permanent damage. 

• Third and Fourth degree frostbite are quite severe; they result in permanent damage and may require amputation. 

• Treat Hypothermia and any other life threatening problems first.

• The symptoms of each degree of frostbite are as follows:

First Degree (Frostnip)

• Warnings includes redness, pain, burning, stinging, or prickly sensation

• Following the early warning signs, pain disappears and there is a sudden blanching of the skin  (It turns white, gray, or waxy looking)

• The skin may look mottled

• Skin is firm to the touch but resilient underneath

• On thawing, there is aching, pain, or brownness.

• The skin may peel off, and the part may remain cold for some time

• The rewarming process should take 30 minutes

Second Degree (Superficial Frostbite, Frostbite)

• All signs and symptoms of first degree frostbite can occur

• No pain; the part may feel dead or “ like a stump “

• Numbness; the part may be immobile or very hard to move

• Tissue is hard to the touch, including underneath layers

• After thawing (takes 3 to 20 days), pain, large blisters, sweating

• Black or discolored skin sloughs (falls) off, leaving tender new skin

Third Degree (Severe Frostbite)

• The full thickness of the skin is involved

• After thawing, aching and throbbing continue for 2 to 5 weeks

Fourth Degree (Frostbite Severe)

• The full thickness of skin and bone are frozen

• Swelling and sweating occur in affected areas

• Black, hard scabs form, surrounded by blisters that slough off, leaving ulcers which heal in about 60 days

• After thawing, affected skin becomes black and shriveled or mummified

• Gangrene may develop

• Amputation may be necessary

Treatment Of Frostbite

Take the following steps to treat frostbite:

• Do not rub the affected area with snow, hold it over fire, or use cold water to thaw it out

• Exercise the affected area to promote blood circulation

• Place victim’s hands in armpits or crotch, blow warm air on victim’s nose, place victim’s foot inside your shirt against chest, etc.

• Make certain that insulation is adequate to prevent recurrence or further injury, check for hypothermia

• Cover the frostbitten area and insulate it to prevent further injury

• Do not attempt to thaw frostbitten limbs in the field.

• It is less harmful for the victim to walk out on a frostbitten limb than to thaw it in the field. 

• Thawing only risks additional injury and the victim will be in too much pain to walk.

• Check for hypothermia

• Once the injury is thawed, the victim must be carried

• However, if partial thawing occurs while walking, the victim should continue to walk out to avoid refreezing the part

Once at a suitable facility:

• Rewarm affected areas rapidly using water at about 105 degrees F (41 degrees C)

• Be certain the water does not exceed 100 degrees F (43.3 degrees C) or you may harm victim

• Thaw frozen boots, gloves, etc.  While on the part, and then gently remove them or cut them away carefully

• Gently wash the area with soap

• Discontinue warming when the part becomes flushed

• Dry the area thoroughly and gently

• Place gauze pads or cotton between fingers and toes

• Dress the entire part with suitable bandages

• Provide bed rest and elevate the frostbitten area

• Check for Hypothermia

• Make certain the person is transported to a hospital or seen by a physician as soon as possible

• Don’t be overzealous in your application of heat - make sure you do not go above 100 degrees F (43.3 degrees C).