HCA Healthcare shares how to fend off frostbite as temperatures turn frigid across U.S.

Over Christmas weekend, Winter Storm Elliott brought freezing temperatures, blizzard conditions and flooding to HCA Healthcare communities across the country. While our HealthONE hospitals in the Denver area are certainly used to seeing their fair share of colder weather, this past week was one for the history books. Denver International Airport hit a recorded low of 24 degrees below zero. Residents in the Mid-South and the Carolinas grappled with managed power cuts to prevent grid failure. Even HCA Healthcare Florida saw temperatures dip into the 20s early Sunday morning across northern and central Florida.

Stay safe indoors

With plenty of the winter season left on the calendar, Dr. Marc Grossman, free-standing emergency department medical director and emergency medical services director at HCA Healthcare’s Portsmouth Regional Hospital and Parkland Medical Center in New Hampshire, encourages us to stay indoors if possible during extreme winter weather.

According to the Centers for Disease Control and Prevention, carbon monoxide (CO) exposures and poisonings occur more often during the fall and winter, when people are more likely to use gas furnaces and heaters.

“If you are using a heating system, make sure your chimney, vents and flues are cleaned out every year as we tend to see a fair number of carbon monoxide poisoning during this time of year from smoke inhalation. Debris can block ventilation,” said Dr. Grossman.

“If using a generator because you lose power, place it in a well-ventilated space, outside. Never run a generator where exhaust can vent into an enclosed area.”

Winter injury prevention

If you must go out, preparation is key to prevent any cold-related injuries.  

“If it is going to be icy outside, it is a good idea to put out salt before it freezes over,” says Dr. Grossman. “This will prevent falls which is something we see very common in both elderly and young patients alike. Hard falls on ice can lead to devastating orthopedic and brain injuries.”

With the potential for more rain, ice and snow this winter, there comes the risk for another significant winter-related injury – frostbite.

Dr. Grossman says frostbite is one of the most common injuries physicians treat during periods of extreme winter weather. “If you are going to be outside for an extended period of time, make sure your head is covered as it is a common source for heat loss,” Dr. Grossman precautions. “You should also wear gloves, socks and boots to stay warm in the cold temperatures.”

Below, Dr. Grossman shares how to stay safe this winter by learning about the risk, signs, symptoms and treatment of frostbite.

What is frostbite?

In the simplest terms, frostbite is when an individual’s skin tissue freezes. And when the tissues freeze, it can release certain chemicals in the body that actually cause the skin to become damaged. Frostbite is the damage from that freezing process.

How long does it take for someone to get frostbite?

It varies. It depends on the temperature, the duration of the exposure and the person’s underlying health. It also depends on things like wind or whether the individual is wet or dry.

For example, normally, if there is a wind chill of 18 degrees below zero, a person can get frostbite in 30 minutes. But if the wind chill gets down to 32 degrees below zero, someone can get frostbite in 10 minutes; with a wind chill of 48 degrees below, a person can get frostbite in under five minutes.

When it’s bitter cold people really need to make sure they remain inside, if possible, and don’t stay exposed for very long.

What are some ways to prevent frostbite?

The easiest ways to prevent frostbite is to not get exposed to the cold; stay inside. If a person has to be outside and exposed, then they need to:

• dress in layers,
• avoid getting wet, and
• make sure exposed skin is covered.

“Covered” means by some type of clothing – including coats, gloves, hats, scarves and socks. There are creams and protective lotions that are advertised for people’s skin, but it has not been shown to really protect from frostbite.

How do you recognize frostbite?

It’s like a burn – there’s mild, moderate and severe.

Mild: In the early stages of mild frostbite, an individual may see a little redness and swelling. Usually, the patient will have some kind of stinging or burning that might start throbbing later on. They may also see sloughing (shedding) of the skin, which is not anything to be concerned about. There typically won’t be any blisters at this stage.

Moderate: Second-degree frostbite would involve deeper tissues or a more widespread injury to the skin. Usually, the individual will see fairly significant swelling, redness and clear blisters that will form within 6-24 hours, on average. The person may also experience some numbness, at first, with aching; but later on, it will become more of a throbbing sensation. In the 1-2 days following, they will start to see more sloughing of the skin and a blackish hue to the skin as well.

Severe: This is the third degree. Here, there’s significant freezing and damage that goes through all of the layers of the skin, even below the skin – the sub-dermal area. In this stage, the person will form hemorrhagic blisters, and if drained, would show a bloody, not clear, fluid. The skin will typically turn a bluish/gray color with this degree of frostbite. Also, people will describe their skin as “feeling weird”, akin to a block of wood. Individuals will sense a fair amount of burning, throbbing and shooting pains. The chance of complete recovery is not all that high in this stage of frostbite.

A relatively healthy person will recover, in time, from the lesser stages of frostbite.

There’s a fourth stage of really, severe frostbite where it not only involves the skin but goes down into the muscle, bones and tendons. That’s when the skin will turn very black and thickened. There will be some deep aching in the joints and, for that, the prognosis is very poor. Most people usually have some sort of removal of that tissue, including amputation.

Who is most at risk?

People who have generally poor health are much more prone to frostbite because those individuals don’t have the mechanism to keep their body warm that healthier people do. Those most at risk include:

• Diabetics
• Smokers (smoking impairs the circulation, which makes one more susceptible to frostbite)
• People with poor circulation
• Elderly, poor or homeless people
• Psychiatric patients
• People under the influence of drugs or alcohol (these individuals are much more likely to make a poor decision and not recognize they’re being exposed to the cold)

What areas of the body are most commonly affected?

The following three areas are usually exposed and most commonly affected.

• Feet: A person’s feet in tight boots can get cold or wet and wetness will increase the chances of frostbite considerably.
• Hands: The hands (and feet) are areas where the circulation isn’t as good as other parts of the body, so it’s harder to keep those areas warm.
• Face: The face has good circulation but the nose and ears – the most prone – are usually exposed.

What’s the best way to treat frostbite?

The best way is to get the person out of the cold as soon as possible and perform rapid re-warming – using warm water between 104 and 107 degrees (the temperature you would find in a hot tub or Jacuzzi).

It is recommended that an individual is not warmed until they are in a definitive warm environment. There is actually worse damage being done if a person is warmed and then refreezes. So, get the person to a warm place, rapidly warm them and then monitor. That’s the easiest way to treat potential frostbite.

It’s very hard to know what degree of frostbite one has in the initial stages. It takes monitoring over a day or two to know if it’s first, second or third degree because it all starts out looking the same.

What are some complications of frostbite?

Sensitivity to cold is the main complication. Even after the frostbite has healed, some people continue to have this problem. It could be permanent damage. We don’t understand why that is, but it’s a very common complication.

Infection is another potential complication. If the frostbitten part is not well taken care of, there could be an infection on top of the frostbite.

Amputation also might have to be considered if the frostbite doesn’t heal or if there’s permanent damage that is not regenerating.

What’s one thing people should know about frostbite?

If someone is planning to do an outdoor activity in below freezing temperatures, they need to not only look at the temperature but at other factors as well, including:

• wind chill,
• a wet environment; and
• general health. If the person(s) is not healthy, they should think twice about exposing themselves to the weather.

We can’t stress enough the importance of dressing in layers and being cognizant of the duration of their exposure to bad elements. As long as individuals are vigilant about those things, they can minimize the risk of frostbite. It’s when people drink alcohol and impair their judgment that they can get into trouble. Vigilance is really the key to everyone’s safety.